Friday, February 12, 2010

Diarrhea and HIV











Today we discussed diarrhea in the setting of HIV.

As a general rule, whenever faced with a new (or worsened) problem in the setting of a pre-existing disease, a useful dichotomy is whether this new problem is related or unrelated to the underlying disease. Pts with underlying HIV are still "entitled" to have the more common causes of diarrhea (or any other presentation)

Diarrhea, weight loss, malnutrition, and wasting was interestingly one of the first described syndromes of what came to be known as AIDS in 1985; it was initially called "slim disease" by African populations, as this Lancet article describes

Clinically significant diarrhea occurs in about 50% of HIV-infected patients in North America. The majority of these patients have an identifyable enteric pathogen if extensive enough workup is done. There is a small subset of HIV patients with "HIV enteropathy", in whom there is no identifyable pathogen. This is likely due to the effect of HIV itself and inflammation involving the GI lymphatic tissue.

Diarrhea may be more characteristic of small bowel pathology (post-prandial, voluminous, associated with weight loss and malnutrition) or large bowel pathology (frequent, small volume, with possible blood and mucous, tenesmus).

One way to approach the MANY opportunistic and other causes of diarrhea is by CD4 count:

Any CD4 count:
Bacterial: C. Diff, salmonella, shigella, campylobacter
Mycobacterial: M. TB
Parasitic: strongyloides, cyclospora, isospora, entamoeba histolytica, giardia lamblia

CD4 below 200: all of above and
Histoplasma capsulatum
Coccidioides

CD4 below 100: all of above and
Cryptosporidium (shown above)
Microsporum
Leishmaniasis

CD4 below 50: all of above and
MAI
Cryptococcus
CMV

Treatment is generally targeted at the identified pathogen. See Table 3 in below paper for details on specific agents for each of above.
Non-specific treatments include anti-diarrheals, low fat diet, nutritional support, and avoidance of lactose

Link:
Click here for a 2009 review from Gastroenterology on HIV and diarrhea (need journal access)

4 comments:

  1. I really appreciate Dr AKHIGBE, my name is LAURIE HUGHES. Dr. AKHIGBE, happiness is over, I never think that I would be cured of the HIV virus. Dr. AKHIGBE did it for me. HIV-under-under-death-HIV-HIV-HIV-Is from 2 years ago, I had spent a lot of money every day going to church. residence. The constant checks were my hobby until I was faithful, I saw a testimonial about how Dr. AKHIGBE had been diagnosed HIV-positive on the Internet by HIV on the Internet. for him, he asked me to do some things that I did, he told me that he would treat me as a doctor, I was released from the deadly disease, so far no HIV in me, it is simply asked to display the testimony of the world, I do not know what to say, all the testimony of DR AKHIGBE's father is great, I owe him in return. If you encounter a similar problem, simply send him an email at drrealakhigbe@gmail.com or his mobile phone number at +2348142454860. It can also cure these diseases like HIV and AIDS. drrealakhigbe@gmail.com ... or what APP .. + 2348142454860 he is a really good and honest man.

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  2. Am Abdul Hakim so joyful giving this testimony of genius herbalist,Dr Moses anabic herbal home whom cured me of liver cancer.i was diagnosed of liver cancer 2years back I tried to cope with the sickness but unfortunately it had gone so bad,I went to so many medical centres I was told to go for a special xray which was computed tomography scan.it's result came out that my liver was rottening and was told that there was no cure,I collapsed there at the centre after getting myself an individual who came for a test after being cured from hiv,then gave me an email address of dr Moses anabic so I contacted him and he assured me of a total cure after three weeks of administering his herbs and I was cured totally.nothing is impossible for God almighty any individual suffering from any illness or virus no matter how bad it may be,don't ever think it's impossible.contact him through his personal email address via MOSESANABIC@GMAIL.COM or write him on WhatsApp with +2348100661264.thank you very much doctor Moses.

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  3. I'M TOTALLY FREE FROM HERPES VIRUS
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  4. Here is  my testimony on how I was cured of HIV by Dr Akhigbe,with his natural herbal medicine.  on a regular basis in efforts to help others when I could. As you may know, each donation is tested.  Well, on July 6th I had a meeting with a Red Cross representative and was told that I had HIV. “What went through your mind when you heard that "Rose" Good question reader! To be honest, I thought my life was over, that I would ever find love, get married, have children or anything normal. Lucky for me I have an amazing support system.  My family supported me then I never thought that I was invincible to STD s or pregnancy or anything else parents warn their kids about. I just didn’t think about it. I was in a monogamous relationship and thought that I asked the right questions.  We even talked about marriage Scary.  During that time I was in college and donated blood on a re as well. who helped me in search of cure through the media.there we saw a good testimony of sister 'Kate' about the good work of Dr Akhigbe natural herbal medicine cure.then I copied his email address and contacted him. A good herbalist doctor with a good heart, he is kind, loving and caring. He replied back to my message and told me what to do. After a week the doctor sent me my herbal medicine and instructed me how to take it.Yes it worked very well, after drinking it I went to the hospital for another test and everything turned negative. What a wonderful testimony I can never forget in my life. Dr Akhigbe is a man who gave me a life to live happily forever so all I want you all to believe and know that cure of HIV is real and herbs is a powerful medicine and it works and heals.  Dr Akhigbe also used his herbal medicine to cure diseases like:   HERPES, DIABETES, SCABIES, HEPATITIS A/B, STROKE, CANCER, ALS, TUBERCULOSIS, ASTHMA, PENIS ENLARGEMENT, MALARIA, LUPUS, LIVER CIRRHOSIS, DEPRESSION, HIV/AIDS, EPILEPSY, BACTERIAL, DIARRHEA, HEART DISEASES, HIGH BLOOD PRESSURE, PARKINSON'S, ALZHEIMER, COLD URTICARIA, HUMAN PAPILLOMAVIRUS,INSOMNIA,  BACTERIAL VAGINOSIS, SCHIZOPHRENIA, JOINT PAIN, STOMACH PAIN, CHROME DISEASES, CHLAMYDIA, INSOMNIA HEARTBURN, ,  THYROID, MAR BURG DISEASES, MENINGITIS, ARTHRITIS, BODY WEAK, SMALLPOX, DENGUE, FEVER, CURBS, CHANCRE, AND OTHERS VARIOUS DISEASES/ VIRUS.   You are there and you find yourself in any of these situations, kindly contact Dr Akhigbe now to help you get rid of it. Here is his email address:
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      My appreciation is to share his testimony for the world to know the good work Dr Akhigbe has done for me and he will do the same for you.
       

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