Diarrhea is a very common problem in people living with HIV. It has been reported that up to 60% of patients with AIDS suffer from diarrhea and, in at least 30% of patients, the cause cannot be determined. Chronic (long-term, constant) diarrhea can cause dehydration, vitamin and mineral loss, malnutrition, weight loss and more. Treating diarrhea, either by eliminating the cause or treating the symptom, is vitally important.

Try to Find the Cause and Treat It

Find out if you are lactose intolerant. Lactose is not only found in milk and dairy products, but it is also found in some medications. If you are lactose intolerant, ask your pharmacist if any of the drugs you take contain lactose.

Rule out any pathogens which may be the cause of the diarrhea. Your physician can check for bacteria including: Salmonella, E. coli, Shigella, Clostridium difficile, Yersinia and/or Camplobacter jejuni; and parasites such as Giardia lamblia, Entamoeba histolytica, Cryptosporidium, Isopora belli, Cyclospora and Microsporidia. Viruses including CMV, rotavirus, adenovirus, astrovirus and picobirnavirus can also cause diarrhea. Fungal infections such as histoplasmosis and coccidiomycosis may also contribute to diarrhea. If the pathogen is identified, treat appropriately.

One study of 194 HIV-infected individuals with diarrhea reported on in The AIDS Reader identified 28% of their participants suffering from two or more pathogens, so if symptoms persist after treatment of identified pathogens, it may be an indication for further examination for additional pathogens not uncovered in earlier tests.

Many of the antiretrovirals may cause diarrhea. The ones most commonly associated with diarrhea include ddI (Videx), abacavir (Ziagen), nelfinavir (Viracept), ritonavir (Norvir), and amprenavir (Agenerase). Depending on the success of your existing regimen, and your choices of antiretrovirals available, you may choose to switch drugs to eliminate the diarrhea, or continue on the same regimen and treat the diarrhea.

Treatments for Diarrhea

  1. The drugs Imodium and Lomotil are often the first choice of treatments, and have been used successfully by many people living with diarrhea. Imodium is available either over-the-counter or by prescription. Lomotil is available only by prescription.

  2. Calcium has been shown to help control diarrhea in patients taking nelfinavir (Viracept). A 500 mg. calcium supplement taken twice a day reportedly improved the diarrhea in all patients in this small study presented at last year's ICAAC. Although it was only studied with nelfinavir, hopefully the results will translate to diarrhea caused by other antiretrovirals as well.

  3. Shaman Botanicals Normal Stool Formula has been tested in numerous clinical trials and appears to be very effective against diarrhea. Although fairly expensive, this product may be worth trying if the diarrhea isn't being controlled by other means. You can find out more about SB Normal Stool Formula through buyer's clubs such as AIDS Treatment Initiatives in Atlanta, or select pharmacies such as CPS.

  4. Oat Bran lessened diarrhea in 84% of a study of 51 people on protease inhibitors who suffered from diarrhea. This study, reported on in Positively Aware, showed an either moderate or dramatic improvement in diarrhea after two weeks of treatment with oat bran tablets. The participants took either two or three Solgar brand unprocessed oat bran tablets, with best results coming from taking the tablets a half-hour before meals or right after each protease inhibitor dose.

  5. Psyllium (i.e. Citrucel, Metamucil) can be helpful in decreasing the frequency of watery stools. Psyllium bars, likely available in health food stores, are a different form of this product that has already showed effectiveness against diarrhea in HIV-infected patients in one small study.

  6. Pancrelipase (Ultrase), a prescription strength digestive enzyme, is currently being studied for its effectiveness in non-infectious, HIV-associated diarrhea. The pilot study suggests efficacy in decreasing the frequency of diarrhea.

Additional Tips to Help with Diarrhea

  1. Rehydrate! Drink plenty of water to replace that which you lose through diarrhea. Drink water, fruit juices (not apple or prune), ginger ale and electrolyte replacement drinks like Gatorade.

  2. Eat smaller, more frequent meals each day.

  3. Try the BRAT diet: Bananas, Rice, Applesauce and Toast.

  4. Eat foods high in potassium, which is lost during diarrhea. Foods high in potassium include: bananas, peaches, potatoes, fish, tomatoes and chicken.

  5. Take supplements that replenish the friendly bacteria in your intestines. Acidophilus, or other probiotics, taken before each meal help with digestion and absorption of nutrients from the food.

  6. L-Glutamine, an amino acid, helps with reducing diarrhea.

  7. Optimune brand whey protein powder has been shown to help reduce the gas and diarrhea that people get from protease inhibitors.

  8. Pancreatic enzymes have shown success at reducing gas, bloating and diarrhea in patients with HIV. Available by prescription, Ultrase MP20 is one combination of enzymes that may be covered by your insurance. You can also get pancreatic enzymes at health food stores or buyer's clubs.

  9. Avoid caffeine as it speeds up the intestinal track and increases diarrhea.

  10. Avoid high-fat, greasy foods.

  11. Avoid foods high in concentrated sugar.

  12. Decrease your intake of insoluble fiber that does not dissolve. Foods containing insoluble fiber include corn, dried fruits, nuts, seeds, popcorn, whole wheat breads and cereals.

  13. Other foods that are good: apples (not the skins or apple juice), white rice, peas, oatmeal, canned fruit, pasta, yams and squash.

  14. Other foods that are to be avoided: beans, broccoli, cauliflower, cabbage, green leafy vegetables, Brussels sprouts and spicy foods.

Recommended Readings

  1. Diarrhea - It's Not Something That You Just Have to Learn to Live With, by Marcy Fenton, M.S., R.D.

  2. Try Conquering Diarrhea by Managing Your Diet, by Janelle L'Heureaux, M.S., R.D. Both of these articles are from Positive Living, a monthly publication for people with HIV/AIDS, from AIDS Project Los Angeles, February 2000 issue.

  3. Stink Balms, by Lark Lands, Ph.D. POZ Magazine, August 1998