Main Article Content
Chronic non-infectious diarrhea is estimated to occur in approximately 5% of all HIV-infected persons in the United States. The two main etiologies are HIV enteropathy and antiretroviral- associated diarrhea. The initial evaluation should focus on determining if the diarrhea is truly chronic, and excluding infectious etiologies. Treatment options for chronic non-infectious diarrhea are limited, but there is one FDA-approved drug (crofelemer) specifically approved for use in this setting. In addition, powdered serum bovine immunoglobulin (a “medical food” per the FDA) shows promise, but studies in humans have been small. This brief article will review the etiology, diagnosis, evaluation, and management of this condition.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2) MacFarlane K. Napo Pharmaceuticals, data on file, personal communication.
3) Clay PG and Crutchley RD. Noninfec-tious diarrhea in HIV seropositive individuals: a review of prevalence rates, etiology, and management in the era of combination antiretroviral therapy. Infect Dis Ther 2014;3:103-22.
4) Bode H, Lenzer L, Kraemer O, et al. The HIV protease inhibitors saquinavir, ritonavir, and nelfinavir induce apoptosis and decrease barrier function in human intestinal epithelial cells. Antivir Ther 2005;10:645-55.
5) Braga Neto MB, Aguiar CV, Maciel JG, et al. Evaluation of HIV protease and nucleoside reverse transcriptase inhibitors on proliferation, necrosis, apoptosis in intestinal cells and electrolyte and water transport and epithelial barrier function in mice. BMC Gastroenterol 2010;10:90.
6) Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006;130:1480-91.
7) Romanic MR, Coraine LA, Maielo VP, et al. Saccharomyces cerevisiae fun-gemia in a pediatric patient after treat-ment with probiotics. Rev Paul Pediatr 2017;35:361-4.
8) Appel-da-Silva MC, Navarez GA, Pe-rez LRR. Saccharomyces cerevisiae var. boulardii fungemia following pro-biotic treatment. Med Mycol Case Rep 2017;18:15-17.
9) Leonard C, Chordia P, MacArthur RD. Profile of crofelemer for the sympto-matic treatment of diarrhea in HIV-infected persons. Botanics: Targets and Therapy 2015;5:21- 5.
10) MacArthur RD, Hawkins TN, Brown SJ, et al. Efficacy and safety of cro-felemer for noninfectious diarrhea in HIV-seropositive individuals (AD-VENT trial): a randomized, double-blind, placebo-controlled, two-stage study. HIV Clin Trials 2013;14:261-73.
11) MacArthur RD, Clay P, Blick G, et al. Long-term crofelemer provides clini-cally relevant reductions in HIV-related diarrhea. Abstract WEPEB0537. 9th IAS Conference on HIV Science; Paris, France, 23 – 26 July 2017.
12) Asmuth DM, Ma Z-M, Albanese A, et al. Oral serum-derived bovine immu-noglobulin improves duodenal immune reconstitution and absorption function in patients with HIV enteropathy. AIDS 2013;27;2207-17.