HIV Related Diarrhoea-Acute

DEFINITION: Three or more liquid stools daily for 2 to 14 days in patients with symptomatic HIV infection.

Management of diarrhoea should be broadly along the same lines as that described in the chapter on Gastrointestinal Conditions.

Note: Anti-diarrhoeals should NOT be used in the initial treatment of acute diarrhoea, especially in children or with bloody diarrhoea cases.

If there is no improvement after 5 days, attempt to identify pathogen through stool microscopy, culture and sensitivity tests then treat according to the result.

HIV Related Diarrhoea - Chronic

DEFINITION: Three or more liquid stools daily continuously or episodically for more than 1 month in patients with symptomatic HIV infection.

Management

Assess for dehydration, malnutrition, and check electrolytes for
Rehydrate as required, maintain
Initially treat diarrhoea with blood in stool and/or fever as acute
If diarrhoea (without blood/fever) continues after conservative management for 14 days, and exclusion of common causes of acute diarrhoea, symptomatic anti-diarrhoeal treatment may be appropriate:

	Medicine	Adult dose	Frequency	Duration
	loperamide po	4mg stat then 2mg after each loose stool as needed		review
or	Codeine phosphate	30-60mg	≤4 times a day	7 days

CAUTION: Only use the above agents if diarrhoea is disabling. Before constipating agents are given, rule out helminth infestation.

If diarrhoea continues or recurs within 3 weeks, and no pathogen is identified, repeat microscopy and C/S.
If there is weight loss investigate for concurrent disseminated TB with CXR and stool for AAFBS

In cases of diarrhoea with fever, bloody and/or mucus; ensure Culture and sensitivity testing is conducted.

If no diagnosis:

Medicine	Adult dose	Frequency	Duration
Ciprofloxacin po	500mg	twice a day	7 days

If no improvement OR very ill/toxic admit to hospital for iv fluids and:

	Medicine	Adult dose	Frequency	Duration
	Ciprofloxacin po	500mg	twice a day	7 days
and	Ceftriaxone IV	1g	twice a day	maximum 7 days

If bloody diarrhoea:

Medicine	Adult dose	Frequency	Duration
Ciprofloxacin po	500mg	twice a day	5 days