Chronic diarrhoea in a human immunodeficiency virus/acquired immunodeficiency syndrome patient: A case report

Chronic diarrhoea in people living with human immunodeficiency virus (PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge, often resulting from opportunistic infections (OIs), malignancies, or disease progression itself. We present a case of an advanced human immunodeficiency virus (HIV) patient with chronic diarrhoea, significant weight loss, and antiretroviral therapy (ART) non-compliance, highlighting the diagnostic dilemma between HIV wasting syndrome, OIs, and malignancy.

A 36-year-old female, diagnosed with HIV five years ago on family screening, presented with three months of profuse watery diarrhoea, associated with crampy abdominal pain and weight loss (14 kg, 30% in 3 months). She was non-compliant with ART. There was no history of recent travel, food contamination, or tuberculosis contact. Fever episodes were mild and transient. Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly. Genital examination was unremarkable. Routine investigations revealed severe anaemia and confirmed PLHIV status. CD4 count was < 36 cells/µL. Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis. After ruling out OIs, ART was restarted. With treatment, her diarrhoea resolved, and she tolerated oral intake. Nutritional support was provided, and she was discharged in stable condition with ART, prophylactic antibiotics, and follow-up instructions for further evaluation.

In ART-noncompliant PLHIV with chronic diarrhoea, distinguishing between HIV wasting syndrome, OIs (Cryptosporidium, Mycobacterium avium complex, cytomegalovirus colitis) and malignancies (non-Hodgkin lymphoma and anal carcinoma) are critical. Gradual CD4 decline, systemic inflammation, and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy. Early recognition and management, including ART reinitiation and nutritional support, are crucial for prognosis.