Symptoms of colitis or small-bowel watery diarrhoea are common among HIV-infected patients. When they are severe they constitute the most distressing manifestations of HIV infection. Small-bowel diarrhoea can result from extensive Kaposi lesions and possibly from the cytopathic effect of HIV. However, many cases result from bacterial, protozoal or helminthic colonisation.
Whenever possible, the cause of the diarrhoea should be established and specific treatment provided. Failing this, management is symptomatic. A high energy and protein intake reduces the degree of muscle wasting. The use of anti-diarrhoeal agents such as codeine phosphate is justified when symptomatic relief is a major consideration.
Bacterial infection: Shigella, and Salmonella species
Protozoal infection: Cryptosporidium species, Giardia lamblia, Isospora belli, Entamoeba histolytica, Microsporidium species.
Mycobacterial infection: M. avium complex
Fungal infection: Candida species
Viral infection: Cytomegalovirus, herpes simplex virus.
Non infectious disorders: Kaposi’s sarcoma, lymphoma, cytopathic effect of HIV disease |
Summary of treatment of gastro intestinal tract/diarrhoeal disease
| |
1st line treatment |
Cryptosporidiosis |
symptomatic treatment |
Isospora belli infection |
sulfamethoxazole/trimethoprim (960 mg 4 x day for 10 days) |
Microsporidiosis (Microspora) |
albendazole 400 mg bd. for 4 weeks |
Shigella sp. |
local sensitivities (or ciprofloxacin 500 mg bd. for 7 days) |
Salmonella sp. |
local sensitivities (or ciprofloxacin 500 mg bd. for 7 days) |
Campylobacter sp. |
erythromycin 500 mg 3 x day for 5 days |
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