Diarrhea can be caused by many
different factors (so, once again, it's
important to find out the cause in case
other medications or warnings may be
Bacterial infections, such as
salmonellosis and shigellosis, which
cause most cases of food poisoning
Viruses, such as herpes,
cytomegalovirus and norovirus
Parasites, which may live in
contaminated drinking water
or be transmitted sexually (e.g.,
Cryptosporidium, Entamoeba histolytica,
Giardia and microsporidia), are more
common in HIV-positive people with a
CD4 count below 200
Foods, especially those that your body
may have trouble digesting, such as milk
products and spicy meals
Medications -- not just certain HIV
meds, but other medications you may
Vitamins and supplements -- for
example, high doses of vitamin C, whey
protein or creatine
HIV can directly cause diarrhea
through its effects on the lining of your
small intestine if your CD4 count is
Mental stress or anxiety
Other diseases, including irritable
bowel syndrome, inflammatory bowel
disease, diabetes, some cancers and
People with HIV are at risk for changing bowel movements, and may tend to "normalize" the changes because they simply get used to them.
WHAT IS IT?
Diarrhea usually means
watery stools several
times a day for several
days in a row. Regularity
is key in determining
a "normal" bowel
movement. For most
people, this means two or
three times a day. Normal
stool is usually not
extremely hard, but isn't
watery either. When you
have bowel movements
much more frequently
than is usual for you and
your stool is extremely
watery, that's when you
may have diarrhea. Just
having watery stool
once doesn't necessarily
mean you have diarrhea.
Diarrhea may be
accompanied by nausea,
cramps or bloating.
up close & personal
CD4 Count: 515
Viral Load: Undetectable
Job: Health educator, public speaker and client advocate
SHANA DOESN'T RECALL what it feels like to have
an HIV-free digestive system -- she's been living
with an AIDS diagnosis for her entire adult life. The
brand-new HIV medications she took in the '90s
caused constant diarrhea. "I was fully dedicated to
eating organic, and taking supplements," she says;
"but it didn't matter what I ate."
She recalls that the diarrhea caused by Crixivan was
"not like regular diarrhea; it was like your body was
rejecting everything in a huge rush." Once she was
unable to beat that rush home -- and ended up with
a speeding ticket. "I was crying, and the cop asked
me why I was speeding. I blurted out: 'Because I
have AIDS and I crapped my pants, and my body's
falling apart.' He gave me the ticket anyway."
Nowadays, Shana takes Intelence, Kaletra and
Viread, the sixth regimen she's taken since 1995;
and she's learned what keeps her gut symptoms at
bay: "I cannot eat fast food; it goes right through me.
I know that I have to be really careful what kind of
water I drink; it has to be purified. And I really have
to make sure that I eat enough fruits and vegetables
and get enough good fiber."
"In getting used to the effects of meds, you go through
stages: Can I live with this? Can I adjust to it?"
Are HIV Meds to Blame?
The following HIV meds seem to be most commonly associated with diarrhea:
cobicistat (a component of the combination pill Stribild)
However, remember that taking one of these medications doesn't automatically mean you'll be dealing with diarrhea.
Diarrhea caused by HIV meds usually lasts only for the first few weeks after you've begun a new medication and then decreases.
Consider all the medications you may be taking for non-HIV related problems.
While most of today's HIV meds are well tolerated, all currently available HIV meds have the potential to cause diarrhea.
"The antidiarrheal medicine, to me, just felt opposite of what my body was trying to do. My doctor was very open-minded to different approaches to deal with diarrhea." -- Shana, diagnosed in 1994
How to Treat Diarrhea
THERE ARE MANY WAYS to treat and/or control your diarrhea, which may help you stay adherent to your HIV meds. In the case that there is no treatment, your doctor may switch you to another medication.
Over-the-counter meds. The most popular are Imodium A-D, Pepto-Bismol and Kaopectate.
Supplements. Fiber supplements --
such as Benefiber, Citrucel, Metamucil
and oat bran tablets -- can help. So can
a wide range of other chemicals and
herbs, such as L-glutamine, calcium
carbonate (when taken with meals),
acidophilus capsules (especially with
psyllium added), ginger (in capsules,
in teas or even raw), nutmeg and
Prescription meds. Fulyzaq
(the only antidiarrheal medication
approved just for people living with
HIV), Lomotil, camphorated tincture of
opium and subcutaneous Sandostatin
can be prescribed by your doctor.
Diarrhea & Your Diet
THE WAY WE EAT CAN MAKE DIARRHEA WORSE. The BRAT diet -- Bananas, Rice,
Apples (fruit, sauce or juice) and Toast -- is one way of helping improve diarrhea.
THE WAY WE EAT MAY ALSO HELP LESSEN DIARRHEA. Try not to rush meals. Chew food well before swallowing, and wait an hour or more before being physically active (no running, swimming, sex, etc.).
These foods may help lessen or control diarrhea:
Baked chicken (with no skin or gravy)
Oatmeal and cream of wheat
Plain starches, like mashed potatoes, white toast,
white rice, soup crackers (e.g., saltines), well-cooked
beans and macaroni (no cheese)
Soft fruits and veggies, preferably well-cooked
and with no skins or seeds (like bananas and
These are some foods to avoid or cut down on:
Caffeine in cola, teas and chocolate
Dairy, including milk, cheese and butter -- but plain
yogurt is actually good for your GI system, since
it contains "friendly bacteria" that can be lost with
Oily or greasy foods, including fried food
Raw fruits and vegetables
Anything with seeds, including many types of
whole wheat and rye bread
You Need Water!
DIARRHEA CAN MAKE your body lose
a lot of water in a very short amount
of time -- as much as a gallon a day!
If you don't drink enough water when
you have diarrhea, you can quickly
become weak and dehydrated. When
you become too dehydrated, your
body can go into shock, which is a
life-threatening condition. When you
lose too much fluid, you also lose
electrolytes, which help keep your body
Be sure to drink more clear, non-sweet
liquids (water, non-caffeinated
tea, Pedialyte, club soda and chicken
broth). Avoid non-clear liquids like
milk, and sweet liquids like fruit juice
or cola, as these can actually make
your diarrhea worse.
Make your own rice drink
The "Ask the Experts" forums at TheBody.com are filled with useful advice from experts as well as those living with HIV. In one post, a man who says he had tried every antidiarrheal medication on the market gave his recipe for keeping his diarrhea at bay. He boils a big pot of water and adds about half a cup of uncooked white rice. He cooks it for 45 minutes and a soupy, tasteless, white rice water develops. He drains the liquid into a container and drinks this rice water two or three times during the day, and sometimes eats the overcooked rice as well. He says it is the only thing that has worked for him. Some people add a drop of honey to this to make it taste better.
"I adjust my life around the diarrhea ... But you know, once I sit with my doctor, she's probably going to say, 'Why didn't you talk about this before? We have something that could help you.' "
-- Andrena, diagnosed in 1993
IN ANY CONVERSATION with your health care
provider, honesty is always the best policy. Be as
open and as clear as possible when responding
to any questions. While some questions may be
embarrassing, trust your doctor and answer fully.
Your doctor needs to know everything you've put
in your body over the past few days, because any
of it may be causing your diarrhea. If you're seeing
a new doctor, be sure to mention your HIV status,
medications and CD4 count as this information can be
very important in helping sort out the cause.
Before your doctor's visit, you may want to jot down:
Exactly what your poop has been like (don't be afraid to provide graphic details)
Exactly when your diarrhea started and how often you've had to use the bathroom
Any other unusual things you've been feeling physically
Changes in your diet, especially anything new you ate or drank just before your diarrhea started
New prescription medications, vitamins, supplements or over-the-counter pills/ liquids you've started taking
Any other drugs you've started taking -- even if they're illegal (your doctor won't turn you in)
Places you've recently traveled to, especially if they're outside the U.S.
Anything that's changed in your life lately, like family problems or stress at work
Afterwards, your doctor
may order further blood
or stool tests. If your
symptoms are severe or
persistent, and especially
if your CD4 count is
below 200, your doctor
may request that you
have a colonoscopy or
procedures to look at the
inside of your intestines)
to discover the cause of
your diarrhea. Then, he
or she will decide upon
a course of treatment,
suggest a change of diet
or lifestyle changes. If
your doctor decides
your medications are
the cause, he or she
may decide to switch
It is the doctor's job to
minimize diarrhea. They
want to make sure that
HIV meds cause as few
problems as possible. As
always, it is important
to not stop taking any
of your medications
without talking with your
medical provider first.
How your doctor should help you
If you have any of the following symptoms, call your doctor as soon as possible, since they may be signs of a more dangerous health problem:
Diarrhea that hasn't gone away after more than a couple of days
Diarrhea that has blood in it
Diarrhea that is accompanied by a fever
Vomiting (or can't even keep liquids down or take your meds)
Difficulty urinating (peeing)
Darker urine than usual
Feeling unusually light-headed, confused or unexplainably angry
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