Diarrhoea

Diarrhoea is a common problem for people with HIV. AIDS Action outlines ways to prevent and treat it.

Diarrhoea is the passage of loose stools three or more times a day. Persistent —diarrhoea (lasting more than two weeks) is more common in people who have advanced HIV than in those who do not. For many it is a major problem. The main dangers of diarrhoea are dehydration and malnutrition.

People with HIV-related diarrhoea can become malnourished and loose weight quickly, mainly because they do not eat well because of poor appetite. Also, because weight loss (‘slim’) is associated with HIV, a person with diarrhoea may be assumed to have HIV, and be stigmatised.

Preventing diarrhoea
Good hygiene and nutrition are the best ways to prevent diarrhoea. Drinking boiled water is best, but is often not practical. Washing hands frequently with soap is more practical. Other strategies are to: store food under a cover; wash eating and cooking utensils; wash raw fruit and vegetables; dispose of waste properly; keep anything dirty, such as soiled bedding, out of reach of children.

To prevent and treat diarrhoea, people with I-I IV need nutritious food that is easy to digest (see: Eat well’).

Treating diarrhoea

Common causes of persistent diarrhoea in developing countries include protozoa (microscopic organisms) such as cryptosporidia, isospora and microsporidia. Other causes include bacteria such as shigella and probably viruses. The H IV virus might cause diarrhoea, although there is no conclusive evidence.

The cause of HIV-related diarrhoea varies from one area to another, and is often quite localised. It is useful to identify common causes in an area, and draw up treatment guidelines for the area. Ideally, these should cover the major causes, so that people need not be underestimated individually.

Adults with diarrhoea should:

• Drink more fluids than usual.
• Continue to eat (see: Eating well)
• Take vitamin supplements such as folic acid and vitamins C and A, if available.
• Treat dehydration with oral rehydration salts (ORS).

Relieve symptoms with codeine phosphate, loperatnide or diphen­oxylate. These drugs reduce the pain, volume and frequency of diarrhoea, although possible side effects include dryness of the mouth, sleepiness, loss of coordination, blurred vision and distended abdomen.

Treat the cause of the diarrhoea with treatments such as TMP/SMX (isospora); metronidazole (giardia); albendazole (microsporidia, crypto­sporidia). However, resistance can develop. For example, salmonella and virtually all shigella in Zambia are resistant to these drugs, so people with HIV in Zambia who have bloody diarrhoea should take nalidixic acid and metronidazole. Also consider TB as the cause. Some traditional herbal remedies control diarrhoea.

People who do not respond to these treatments are seriously ill. The main aim should be to relieve their distress, using codeine phosphate or loperamide, and offer fluid - oral rehydration or intravenous fluids in hospital. For someone with fever, try systemic antibiotics such as intravenous or intramuscular cephalosporins.

It is important to keep the area around someone with diarrhoea clean, to prevent infecting other people.

Eating well

People with diarrhoea need plenty to drink and plenty of easily digestible, bulky foods containing a lot of nutrients and calories. Make foods easier to digest by cooking them well or mashing them. Encourage people with low appetites to eat small amounts often.

Take plenty of:

• water, soups and diluted juices
• cereal (such as rice) with beans, meat or fish: oil can be added to increase energy
• yoghurt, eggs, bananas
• other bulky or juicy foods such as potatoes, watermelon, barley, paw-paw, rice water, millet or’ sorghum porridge, steamed fruit.

Avoid:

• high-fibre foods such as whole-grain cereals, or fruit and vegetable peel
• sugary foods or drinks, which can worsen diarrhoea (and provoke thrush)
• raw foods, cold foods, acidic fruit such as oranges
• irritating foods such as pepper

Children
Do not give anti-diarrhoea drugs to children under five years of age. (Give children plenty to eat and drink (see ‘Eating well), plus vitamin and mineral tablets if available. Children will continue to need extra food after the diarrhoea has gone, to enable them to regain any lost weight.