HIV and diarrhoea: what is new?

Area of Science:

• Gastroenterology
• Infectious Diseases
• Immunology

Background:

• Diarrhoea is a common complication in individuals with human immunodeficiency virus (HIV), impacting quality of life and survival despite combination antiretroviral therapy.
• Emerging research highlights the role of Th17/Th22 T cells in mucosal immunity and the gut microbiome in maintaining gut homeostasis.
• Understanding the evolving landscape of infectious and noninfectious causes of diarrhoea in HIV is critical.

Purpose of the Study:

• To review the changing etiologies of infectious and noninfectious diarrhoea in individuals with HIV.
• To discuss the investigation and management strategies for HIV-associated diarrhoea.
• To emphasize the importance of recognizing diarrhoea as an under-reported symptom in HIV care.

Main Methods:

• Literature review of infectious and noninfectious causes of diarrhoea in HIV.
• Analysis of recent findings on gut immunity, microbiome, and specific pathogens.
• Examination of diagnostic workup and therapeutic options.

Main Results:

• Bacterial infections remain significant, particularly in resource-limited settings, with increasing reports of sexually transmitted enteric infections in men who have sex with men, often with antimicrobial resistance.
• Parasitic infections are more prevalent in individuals with uncontrolled HIV and low CD4 counts.
• Noninfectious causes, including antiretroviral therapy side effects and pancreatic dysfunction, are under-recognized but potentially remediable.

Conclusions:

• Clinicians must proactively inquire about diarrhoeal symptoms in HIV patients due to under-reporting.
• A comprehensive diagnostic approach including faecal elastase measurements is recommended.
• Novel agents like crofelemer show promise for managing secretory diarrhoea symptoms in HIV-associated cases.