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Treating Diarrhea in HIV
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Many individuals with HIV experience diarrhea which may or may not
necessarily be completely drug-related. As we age with HIV gastrointestinal
concerns start to emerge. As well, I suspect HIV may certainly affect the
stomach as it does other organs. But very little HIV research is being
conducted in this area. We have little understanding of the causes of
diarrhea except when it is clearly drug related. Perhaps, as we age research
into this area will gain importance. At this year's Lipodystrophy Wksp, there
were 2 abstracts on treating diarrhea.
CR Heiser (abstract 59), from Indiana University, reported on the use of
(Probiotics: acidophilus and bifido-bacteria), Metamucil, and L-Glutamine in
treating nelfinavir-related diarrhea. Agouron was a co-author of the study.
The study protocol was to administer acidophilus and bifidobacteria
(Probiotics) 1.2 grams powder orally on an empty stomach in the morning, and
11 grams of soluble fiber supplement 2 hours after HAART so as not to int
erfere with HAART absorption. If this did not work for a patienta after
4 weeks L-Glutamine was added, titrated up to 30 grams. 16 patients were
randomized to the treatment group and 4 to a standard of care control group
for 12 weeks.
RESULTS
In most patients nutritional interventions used in this study effectively
controlled diarrhea associated with nelfinavir. Synergistic effects of the
dietary component dramatically reduced diarhhea in 15 of 16 (94%) of study
participants. Probiotics and soluble fiber (Metamucil) were associated with
controlling diarrhea in 11 of 16 patients. Adding glutamine to the regimen
further reduced diarrhea in the remaining 5 participants. Perception of side
effects and quality of life measures were significantly improved in the
treatment group. An exercise program was also instituted consisting of
aerobic exercise (biking) and resistance exercise. Nutritional support by
resolving diarrhea and exercise improved functional body composition
outcomes: lean mass was significantly increased when estimated by the 7-site
skinfolds, but not BIA, increased chest and shoulder circumfrances. There
appeared to be a reduction in waist.
In a pilot study on diarrhea in HIV, bicarbonate-buffered pancrelipiase was
administered to evaluate its effect on HAART-induced diarrhea (abstract 62).
15 HIV+ individuals experiencing HAART-induced diarrhea were enrolled in this
blinded crossover study of two 7-day treatment periods (bicarbonate-buffered
pancrelipase vs placebo). 11 patients completed the study while 4 patients
were discontinued due to noncompliance.
The authors found that in the test tube (in vitro) 5 protease inhibitors
(amprenavir solution and amprenavir capsules, ritonavir, nelfinavir, Kaletra,
and saquinavir) caused a significant inhibition of lipase. This inhibition
was reversed and lipase reactivated by the additionof pancrelipase. There was
a significant difference in the consistency of the stools of the patients in
the bicaronate buffered pancrelipase treatment as compared to the placebo
(54% vs 28% of the stools were formed); however, there was no significant
difference in stool frequency. The authors concluded that these study results
justify the co-administration of bicaronate buffered pancrelipase with these
protease inhibitors.
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