BILE-ACID MALABSORPTION IN HIV-INFECTED PATIENTS WITH CHRONIC DIARRHEA

Aims: To look for the presence of bile acid malabsorption in HIV infec ted patients with chronic diarrhoea and determine whether bile sequest ering agents may have a role in palliating this common problem. Method s: Nineteen HIV infected patients with chronic diarrhoea (duration > o ne month) poorly controlled on conventional treatment were investigate d using the seven day retention of (75)seleno-23-homocholic acid tauri ne (SeHCAT) as a measure of bile acid loss from the enterohepatic circ ulation. Patients with evidence of bile acid malabsorption were offere d cholestyramine. Results: Sixteen (84%) had evidence of bile acid mal absorption (<15% retention at seven days). Ten of the 16 patients with bile acid malabsorption had terminal ileal biopsies six had ileitis a nd four normal histology, suggesting that malabsorption is not always related to terminal ileitis. Thirteen patients with bile acid malabsor ption have been treated with cholestyramine and 11 have reported a sym ptomatic response. Conclusions: Bile acid malabsorption can be demonst rated in some cases of HIV associated chronic diarrhoea and we suggest a therapeutic trial of a bile sequestering agent in patients whose sy mptoms are not well controlled using conventional anti-diarrhoeal agen ts.