HIV-Related Diarrhea Is Multifactorial and Fat Malabsorption Is Commonly Present, Independent of HAART

Poles, Michael A.; Fuerst, Marie; McGowan, Ian; Elliott, Julie; Rezaei, Ario; Mark, Dustin; Taing, Philip; Anton, Peter A.
June 2001
American Journal of Gastroenterology;Jun2001, Vol. 96 Issue 6, p1831
Academic Journal
OBJECTIVE: Highly active antiretroviral therapy (HAART) has significantly decreased the incidence of infectious diarrhea affecting HIV-infected patients. Still, diarrhea remains a common symptom in HIV. We sought to determine the incidence of fat malabsorption as a cause of diarrhea in HIV patients receiving non-HAART (nucleoside analog only) and HAART (protease inhibitor-containing) antiretroviral regimens. METHODS: From June, 1995, to April, 1999, 88 HIV-infected patients underwent evaluation for diarrhea, which included endoscopy. We examined the incidence of fat malabsorption with a 24-h stool collection for fecal fat in a cohort of these patients (N = 33). Patients were divided into two groups, those receiving protease inhibitor-containing HAART and those receiving less intensive, nucleoside analog- only, non-HAART regimens. RESULTS: Thirty of 33 patients (90.9%) had fat malabsorption. Twenty of 21 patients not receiving HAART (95.2%) had fat malabsorption with a mean of 34 ± 38 g of stool fat and a mean stool weight of 797 ± 454 g. Ten of 12 patients receiving HAART (83.3%) had fat malabsorption with a mean of 46 ± 86 g of stool fat and a mean stool weight of 800 ± 647 g. Stool weight correlated with the degree of fat malabsorption (R = 0.77). CONCLUSION: Fat malabsorption represents a commonly undiagnosed entity in HIV-infected patients with diarrhea, whether or not they are receiving HAART therapy. Fecal fat determination should be considered a routine part of the diagnostic workup of HIV-infected patients experiencing diarrhea.


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