HIV diarrhea - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:07:44Z

Prepared the page for translation

← Revisión anterior		Revisión del 23:07 4 ene 2026
Línea 1:		Línea 1:
			<languages/>
			<translate>

	==Background==		==Background==
	*Chronic [[diarrhea]] (over 28 days); can be presenting symptom of AIDS
			*Chronic [[Special:MyLanguage/diarrhea\|diarrhea]] (over 28 days); can be presenting symptom of AIDS
	*Less common after introduction of HAART		*Less common after introduction of HAART
	*Acute diarrhea common with normal and low CD4		*Acute diarrhea common with normal and low CD4

			</translate>
	{{HIV CD4 Chart}}		{{HIV CD4 Chart}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Ascertain whether small bowel vs large bowel diarrhea		*Ascertain whether small bowel vs large bowel diarrhea
	**Small Bowel		**Small Bowel
	***[[Diarrhea]] watery and copious		***[[Special:MyLanguage/Diarrhea\|Diarrhea]] watery and copious
	***May have weight loss		***May have weight loss
	***Bloating, gas, cramping		***Bloating, gas, cramping
	***[[Vitamin B12 deficiency]] if terminal illeum involved		***[[Special:MyLanguage/Vitamin B12 deficiency\|Vitamin B12 deficiency]] if terminal illeum involved
	**Large Bowel		**Large Bowel
	***Frequent small volume, possibly painful stools		***Frequent small volume, possibly painful stools
	***[[lower GI bleeding\|Hematochezia]] - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[E. coli]] O157, [[campylobacter]], [[Shigella]], [[Salmonella]], Yersinia)		***[[Special:MyLanguage/lower GI bleeding\|Hematochezia]] - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[Special:MyLanguage/E. coli\|E. coli]] O157, [[Special:MyLanguage/campylobacter\|campylobacter]], [[Special:MyLanguage/Shigella\|Shigella]], [[Special:MyLanguage/Salmonella\|Salmonella]], Yersinia)
	*Weight loss is concerning for infiltrative disease, opportunistic infection		*Weight loss is concerning for infiltrative disease, opportunistic infection
	*Receptive anal sex - consider local [[HSV]], [[Gonorrhea]], [[chlamydia]], [[entamoeba]]		*Receptive anal sex - consider local [[Special:MyLanguage/HSV\|HSV]], [[Special:MyLanguage/Gonorrhea\|Gonorrhea]], [[Special:MyLanguage/chlamydia\|chlamydia]], [[Special:MyLanguage/entamoeba\|entamoeba]]


	==Differential Diagnosis==		==Differential Diagnosis==


	===CD4 200-500===		===CD4 200-500===
	*Consider routine pathogens causing [[Diarrhea]]
	**Viruses ([[Norovirus]], [[Rotavirus]], [[Adenovirus]], Astrovirus, etc.)		*Consider routine pathogens causing [[Special:MyLanguage/Diarrhea\|Diarrhea]]
	**Bacteria ([[Salmonella]], [[Campylobacter]], [[Shigella]], Enterotoxigenic [[E. coli]], [[C. diff]], etc.)		**Viruses ([[Special:MyLanguage/Norovirus\|Norovirus]], [[Special:MyLanguage/Rotavirus\|Rotavirus]], [[Special:MyLanguage/Adenovirus\|Adenovirus]], Astrovirus, etc.)
	**Protozoa ([[Cryptosporidium]], [[Giardia]], [[Cyclospora]], [[Entamoeba]], etc.)		**Bacteria ([[Special:MyLanguage/Salmonella\|Salmonella]], [[Special:MyLanguage/Campylobacter\|Campylobacter]], [[Special:MyLanguage/Shigella\|Shigella]], Enterotoxigenic [[Special:MyLanguage/E. coli\|E. coli]], [[Special:MyLanguage/C. diff\|C. diff]], etc.)
			**Protozoa ([[Special:MyLanguage/Cryptosporidium\|Cryptosporidium]], [[Special:MyLanguage/Giardia\|Giardia]], [[Special:MyLanguage/Cyclospora\|Cyclospora]], [[Special:MyLanguage/Entamoeba\|Entamoeba]], etc.)
	*Side effect of nelfinavir and ritonavir		*Side effect of nelfinavir and ritonavir
	*[[Kaposi sarcoma]]		*[[Special:MyLanguage/Kaposi sarcoma\|Kaposi sarcoma]]
	*[[Cryptosporidium]] parvum (brief course of illness) - severe watery diarrhea		*[[Special:MyLanguage/Cryptosporidium\|Cryptosporidium]] parvum (brief course of illness) - severe watery diarrhea
	*[[C. diff]] if antibiotic exposed		*[[Special:MyLanguage/C. diff\|C. diff]] if antibiotic exposed


	===CD4<200===		===CD4<200===
	*[[Microsporidium]]
	*[[Cryptosporidium]]		*[[Special:MyLanguage/Microsporidium\|Microsporidium]]
	*[[Histoplasma]]		*[[Special:MyLanguage/Cryptosporidium\|Cryptosporidium]]
	*[[Lymphoma]]		*[[Special:MyLanguage/Histoplasma\|Histoplasma]]
	*Enteroaggregative [[Escherichia coli]] (EAEC) (can also affect immunocompetent children)		*[[Special:MyLanguage/Lymphoma\|Lymphoma]]
			*Enteroaggregative [[Special:MyLanguage/Escherichia coli\|Escherichia coli]] (EAEC) (can also affect immunocompetent children)
	*HIV can directly infiltrate bowel wall leading to diarrhea		*HIV can directly infiltrate bowel wall leading to diarrhea


	===CD4 <100===		===CD4 <100===
	*[[Cryptosporidium]] parvum (chronic course of illness)
	*[[M. tuberculosis]] (disseminated disease increasingly likely <100)		*[[Special:MyLanguage/Cryptosporidium\|Cryptosporidium]] parvum (chronic course of illness)
	*[[Cryptococcus]]		*[[Special:MyLanguage/M. tuberculosis\|M. tuberculosis]] (disseminated disease increasingly likely <100)
			*[[Special:MyLanguage/Cryptococcus\|Cryptococcus]]
	*Isospora		*Isospora


	===CD4 <50===		===CD4 <50===
	*[[Mycobacterium avium]] complex (MAC) - infiltration of bowel associated with malabsorption
	*[[CMV]]

			*[[Special:MyLanguage/Mycobacterium avium\|Mycobacterium avium]] complex (MAC) - infiltration of bowel associated with malabsorption
			*[[Special:MyLanguage/CMV\|CMV]]

			</translate>
	{{HIV associated conditions}}		{{HIV associated conditions}}
			<translate>


	==Evaluation==		==Evaluation==

	*Many workups will be non diagnostic		*Many workups will be non diagnostic
	*Start with stool WBCs, cultures, Ova and Parasites x3, C. Dif toxin		*Start with stool WBCs, cultures, Ova and Parasites x3, C. Dif toxin
Línea 62:		Línea 84:
	*Imaging		*Imaging
	**Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions.		**Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions.


	==Management==		==Management==
	*[[electrolyte repletion\|Electrolyte]] and [[volume repletion]]
			*[[Special:MyLanguage/electrolyte repletion\|Electrolyte]] and [[Special:MyLanguage/volume repletion\|volume repletion]]
	*Early consultation of HIV service		*Early consultation of HIV service
	*Nutrition replacement in chronic small bowel disease		*Nutrition replacement in chronic small bowel disease
Línea 70:		Línea 94:
	*Generally, avoid starting antibiotics unless have specific target		*Generally, avoid starting antibiotics unless have specific target
	*Antimotility agents		*Antimotility agents
	**[[Loperamide]]		**[[Special:MyLanguage/Loperamide\|Loperamide]]
	**crofelemer (blocks chloride secretion and approved for HIV diarrhea) 125mg po bid		**crofelemer (blocks chloride secretion and approved for HIV diarrhea) 125mg po bid


	==Disposition==		==Disposition==

	*If near normal CD4 and symptoms consistent with small bowel disease (copious, watery), may be managed as outpatient if no other admission indication		*If near normal CD4 and symptoms consistent with small bowel disease (copious, watery), may be managed as outpatient if no other admission indication
	*Severe dehydration, electrolyte abnormalities, malnutrition, fever, and hemorrhagic diarrhea all may require admission or at minimum very close HIV follow up		*Severe dehydration, electrolyte abnormalities, malnutrition, fever, and hemorrhagic diarrhea all may require admission or at minimum very close HIV follow up


	==See Also==		==See Also==
	*[[HIV - AIDS (Main)]]
	*[[Diarrhea]]		*[[Special:MyLanguage/HIV - AIDS (Main)\|HIV - AIDS (Main)]]
			*[[Special:MyLanguage/Diarrhea\|Diarrhea]]


	==References==		==References==

	<references/>		<references/>
	*UpToDate: "Evaluation of the HIV-infected patient with diarrhea"		*UpToDate: "Evaluation of the HIV-infected patient with diarrhea"
Línea 89:		Línea 119:
	[[Category:ID]]		[[Category:ID]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

ClaireLewis: /* Differential Diagnosis */

2019-09-29T21:24:29Z

Differential Diagnosis

← Revisión anterior		Revisión del 21:24 29 sep 2019
Línea 22:		Línea 22:
	===CD4 200-500===		===CD4 200-500===
	*Consider routine pathogens causing [[Diarrhea]]		*Consider routine pathogens causing [[Diarrhea]]
	**Viruses ([[Norovirus]], [[Rotavirus]], [[~~Adenoviruses~~]], [[Astrovirus]], etc.)		**Viruses ([[Norovirus]], [[Rotavirus]], [[Adenovirus]], Astrovirus, etc.)
	**Bacteria ([[Salmonella]], [[Campylobacter]], [[Shigella]], Enterotoxigenic [[E. coli]], [[C. diff]], etc.)		**Bacteria ([[Salmonella]], [[Campylobacter]], [[Shigella]], Enterotoxigenic [[E. coli]], [[C. diff]], etc.)
	**Protozoa ([[Cryptosporidium]], [[Giardia]], [[Cyclospora]], [[Entamoeba]], etc.)		**Protozoa ([[Cryptosporidium]], [[Giardia]], [[Cyclospora]], [[Entamoeba]], etc.)

ClaireLewis at 21:24, 29 September 2019

2019-09-29T21:24:01Z

← Revisión anterior		Revisión del 21:24 29 sep 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	*Chronic diarrhea (over 28 days); can be presenting symptom of AIDS		*Chronic [[diarrhea]] (over 28 days); can be presenting symptom of AIDS
	*Less common after introduction of HAART		*Less common after introduction of HAART
	*Acute diarrhea common with normal and low CD4		*Acute diarrhea common with normal and low CD4
Línea 9:		Línea 9:
	*Ascertain whether small bowel vs large bowel diarrhea		*Ascertain whether small bowel vs large bowel diarrhea
	**Small Bowel		**Small Bowel
	***[[Diarrhea]] watery and ~~copius~~		***[[Diarrhea]] watery and copious
	***May have weight loss		***May have weight loss
	***Bloating, gas, cramping		***Bloating, gas, cramping
Línea 15:		Línea 15:
	**Large Bowel		**Large Bowel
	***Frequent small volume, possibly painful stools		***Frequent small volume, possibly painful stools
	***Hematochezia - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[E. coli]] O157, [[campylobacter]], [[Shigella]], [[Salmonella]], Yersinia)		***[[lower GI bleeding\|Hematochezia]] - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[E. coli]] O157, [[campylobacter]], [[Shigella]], [[Salmonella]], Yersinia)
	*Weight loss is concerning for infiltrative disease, opportunistic infection		*Weight loss is concerning for infiltrative disease, opportunistic infection
	*Receptive anal sex - consider local [[HSV]], [[Gonorrhea]], [[~~chlamlydia~~]], [[entamoeba]]		*Receptive anal sex - consider local [[HSV]], [[Gonorrhea]], [[chlamydia]], [[entamoeba]]

	==Differential Diagnosis==		==Differential Diagnosis==
	===CD4 200-500===		===CD4 200-500===
	*Consider routine pathogens causing [[Diarrhea]]		*Consider routine pathogens causing [[Diarrhea]]
	**Viruses (Norovirus, Rotavirus, Adenoviruses, Astrovirus, etc.)		**Viruses ([[Norovirus]], [[Rotavirus]], [[Adenoviruses]], [[Astrovirus]], etc.)
	**Bacteria (Salmonella, Campylobacter, Shigella, Enterotoxigenic E. coli, C. ~~dif~~, etc.)		**Bacteria ([[Salmonella]], [[Campylobacter]], [[Shigella]], Enterotoxigenic [[E. coli]], [[C. diff]], etc.)
	**Protozoa (Cryptosporidium, Giardia, Cyclospora, Entamoeba, etc.)		**Protozoa ([[Cryptosporidium]], [[Giardia]], [[Cyclospora]], [[Entamoeba]], etc.)
	*Side effect of nelfinavir and ritonavir		*Side effect of nelfinavir and ritonavir
	*Kaposi ~~Sarcoma~~		*[[Kaposi sarcoma]]
	*Cryptosporidium parvum (brief course of illness) - severe watery diarrhea		*[[Cryptosporidium]] parvum (brief course of illness) - severe watery diarrhea
	*C. ~~dif~~ if antibiotic exposed		*[[C. diff]] if antibiotic exposed

	===CD4<200===		===CD4<200===
	*Microsporidium		*[[Microsporidium]]
	*Cryptosporidium		*[[Cryptosporidium]]
	*Histoplasma		*[[Histoplasma]]
	*Lymphoma		*[[Lymphoma]]
	*Enteroaggregative Escherichia coli (EAEC) (can also affect immunocompetent children)		*Enteroaggregative [[Escherichia coli]] (EAEC) (can also affect immunocompetent children)
	*HIV can directly infiltrate bowel wall leading to diarrhea		*HIV can directly infiltrate bowel wall leading to diarrhea

	===CD4 <100===		===CD4 <100===
	*Cryptosporidium parvum (chronic course of illness)		*[[Cryptosporidium]] parvum (chronic course of illness)
	*M. tuberculosis (disseminated disease increasingly likely <100)		*[[M. tuberculosis]] (disseminated disease increasingly likely <100)
	*Cryptococcus		*[[Cryptococcus]]
	*Isospora		*Isospora

	===CD4 <50===		===CD4 <50===
	*Mycobacterium avium complex (MAC) - infiltration of bowel associated with malabsorption		*[[Mycobacterium avium]] complex (MAC) - infiltration of bowel associated with malabsorption
	*CMV		*[[CMV]]

	{{HIV associated conditions}}		{{HIV associated conditions}}
Línea 59:		Línea 59:
	**Indicated if workup is negative and severely immunocompromised		**Indicated if workup is negative and severely immunocompromised
	**Small bowel biopsy to look for MAC, lymphoma, or Microsporidiosis		**Small bowel biopsy to look for MAC, lymphoma, or Microsporidiosis
	**~~Guaic postive~~ stools and weight loss: consider Kaposi Sarcoma of bowel, diagnosis with colonoscopy		**Guaiac positive stools and weight loss: consider Kaposi Sarcoma of bowel, diagnosis with colonoscopy
	*Imaging		*Imaging
	**Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions.		**Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions.

	==Management==		==Management==
	*Electrolyte and volume ~~replacement~~		*[[electrolyte repletion\|Electrolyte]] and [[volume repletion]]
	*Early consultation of HIV service		*Early consultation of HIV service
	*Nutrition replacement in chronic small bowel disease		*Nutrition replacement in chronic small bowel disease
Línea 70:		Línea 70:
	*Generally, avoid starting antibiotics unless have specific target		*Generally, avoid starting antibiotics unless have specific target
	*Antimotility agents		*Antimotility agents
	**~~loperamide~~		**[[Loperamide]]
	**crofelemer (blocks chloride secretion and approved for HIV diarrhea) 125mg po bid		**crofelemer (blocks chloride secretion and approved for HIV diarrhea) 125mg po bid

ClaireLewis: /* Clinical Features */

2016-12-22T23:24:35Z

Clinical Features

← Revisión anterior		Revisión del 23:24 22 dic 2016
Línea 12:		Línea 12:
	***May have weight loss		***May have weight loss
	***Bloating, gas, cramping		***Bloating, gas, cramping
	***~~Vit~~ B12 ~~deficient~~ if terminal illeum involved		***[[Vitamin B12 deficiency]] if terminal illeum involved
	**Large Bowel		**Large Bowel
	***Frequent small volume, possibly painful stools		***Frequent small volume, possibly painful stools

ClaireLewis: /* References */

2016-10-29T17:05:41Z

References

← Revisión anterior		Revisión del 17:05 29 oct 2016
Línea 88:		Línea 88:
	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]
			[[Category:Symptoms]]

ClaireLewis: /* Clinical Features */

2016-10-05T04:10:56Z

Clinical Features

← Revisión anterior		Revisión del 04:10 5 oct 2016
Línea 17:		Línea 17:
	***Hematochezia - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[E. coli]] O157, [[campylobacter]], [[Shigella]], [[Salmonella]], Yersinia)		***Hematochezia - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria ([[E. coli]] O157, [[campylobacter]], [[Shigella]], [[Salmonella]], Yersinia)
	*Weight loss is concerning for infiltrative disease, opportunistic infection		*Weight loss is concerning for infiltrative disease, opportunistic infection
	*Receptive anal sex - consider local [[HSV]], [[Gonorrhea]], [[~~chamlydia~~]], [[entamoeba]]		*Receptive anal sex - consider local [[HSV]], [[Gonorrhea]], [[chlamlydia]], [[entamoeba]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: Text replacement - "Diarrhea" to "Diarrhea"

2016-09-24T16:39:10Z

Text replacement - "*Diarrhea" to "*Diarrhea"

← Revisión anterior		Revisión del 16:39 24 sep 2016
Línea 9:		Línea 9:
	*Ascertain whether small bowel vs large bowel diarrhea		*Ascertain whether small bowel vs large bowel diarrhea
	**Small Bowel		**Small Bowel
	***Diarrhea watery and copius		***[[Diarrhea]] watery and copius
	***May have weight loss		***May have weight loss
	***Bloating, gas, cramping		***Bloating, gas, cramping

Rossdonaldson1: Text replacement - "assoc " to "associated "

2016-08-24T20:46:48Z

Text replacement - "assoc " to "associated "

← Revisión anterior		Revisión del 20:46 24 ago 2016
Línea 45:		Línea 45:

	===CD4 <50===		===CD4 <50===
	*Mycobacterium avium complex (MAC) - infiltration of bowel ~~assoc~~ with malabsorption		*Mycobacterium avium complex (MAC) - infiltration of bowel associated with malabsorption
	*CMV		*CMV

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T13:01:51Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 13:01 23 jul 2016
Línea 50:		Línea 50:
	{{HIV associated conditions}}		{{HIV associated conditions}}

	==~~Diagnosis~~==		==Evaluation==
	*Many workups will be non diagnostic		*Many workups will be non diagnostic
	*Start with stool WBCs, cultures, Ova and Parasites x3, C. Dif toxin		*Start with stool WBCs, cultures, Ova and Parasites x3, C. Dif toxin

Neil.m.young: Text replacement - "5 mg" to "5mg"

2016-07-19T22:22:58Z

Text replacement - "5 mg" to "5mg"

← Revisión anterior		Revisión del 22:22 19 jul 2016
Línea 71:		Línea 71:
	*Antimotility agents		*Antimotility agents
	**loperamide		**loperamide
	**crofelemer (blocks chloride secretion and approved for HIV diarrhea) ~~125 mg~~ po bid		**crofelemer (blocks chloride secretion and approved for HIV diarrhea) 125mg po bid

	==Disposition==		==Disposition==

HIV diarrhea - Revision history

Ostermayer: Prepared the page for translation

ClaireLewis: /* Differential Diagnosis */

ClaireLewis at 21:24, 29 September 2019

ClaireLewis: /* Clinical Features */

ClaireLewis: /* References */

ClaireLewis: /* Clinical Features */

Rossdonaldson1: Text replacement - "*Diarrhea" to "*Diarrhea"

Rossdonaldson1: Text replacement - "assoc " to "associated "

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

Neil.m.young: Text replacement - "5 mg" to "5mg"

Rossdonaldson1: Text replacement - "Diarrhea" to "Diarrhea"