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HIV-ASSOCIATED DIARRHEA IN THE ERA OF HAART: STILL PREVALENT AFTER ALL THESE YEARS
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Researchers in New York City affiliated with the NY VA Medical Center and New York University Medical Center (Uzma Siddiqui, Edmund J Bini, Khushbu Chandarana, Sabena Ramsetty, Michael A Poles) reported in a poster at DDW on diarrhea in HIV+ individuals.
Prior to the introduction of highly active antiretroviral therapy (HAART) in 1995, HIV-associated diarrhea was highly prevalent. Although anecdotal evidence suggests that HAART has decreased the incidence, morbidity, and mortality of HIV-associated diarrhea, this has not been evaluated in prospective studies. The aims of this study were to determine the prevalence of diarrhea in HIV+ patients in the HAART era and to evaluate the impact of diarrhea on health-related quality of life (HRQOL). Because HAART has stabilized patients and improved overall health and expected longevity, diarrhea has been relegated to a back seat. But patients are still experiencing diarrhea, which does not appear to be getting adequately addressed.
In this study consecutive HIV+ patients seen in infectious disease clinics at two medical centers were enrolled in this study. HIV seronegative patients recruited from primary care clinics served as healthy controls. Diarrhea symptoms were evaluated using a validated questionnaire and HRQOL was assessed using the SF-36 survey.
Baseline characteristics did not differ significantly between the 116 HIV+ patients and the 134 healthy controls. In the HIV+ group, the median CD4 count was 342 cells/mm3 and the median viral load was 155 copies/mL. HIV+ patients reported having diarrhea within the past month significantly more than healthy controls (38.3% vs 19.4%, P<0.001). A greater proportion of HIV+ patients reported having 3 or more bowel movements per day within the past 7 days (26.1% vs 5.2%, P<0.001) and within the last 6 months (27.4% vs 6.0%, P<0.001) when compared to controls. More HIV+ patients described their stool consistency as either loose or liquid within the past month when compared to healthy controls (19.1% vs 7.4%, P = 0.001).
HRQOL scores in HIV+ patients with diarrhea within the past month were significantly lower than in healthy controls for physical functioning (73 vs 84, P = 0.017), role-physical (42 vs 66, P = 0.003), general health (54 vs 67, P = 0.003), vitality (47 vs 60, P = 0.006), social functioning (72 vs 85, P = 0.006), and role-emotional (57 vs 81, P = 0.001). Use of antidiarrheal medications was greater among HIV+ subjects than among healthy controls (14.8% vs 0.7%, P<0.001).
The study authors concluded that diarrhea remains an important problem and significantly impairs HRQOL in HIV+ patients in the HAART era. It is important that healthcare providers specifically evaluate their HIV+ patients for diarrhea so that these symptoms may be optimally managed.
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