STEATORRHEA - A COMMON MANIFESTATION IN PATIENTS WITH HIV AIDS/

Multiple infectious causes of diarrhea are known in patients with HIV/ AIDS. Maldigestion and malabsorption have been reported in patients wi th HIV/AIDS and may be independent of infectious etiologies. Among amb ulatory patients with HIV/AIDS, we examined the prevalence of fat mala bsorption (steatorrhea). Sixty-one patients with unexplained diarrhea (defined as > 2 stools/d) and/or weight loss despite adequate caloric intake (and without clinical evidence of chronic pancreatitis) were ev aluated in our outpatient Gastroenterology-Nutrition Clinic between Ma rch 1, 1993, and July 1994. Patients were instructed by a dietitian to follow a greater than or equal to 100 g/d fat diet for 24 h before su bmitting a stool sample for qualitative (or quantitative) fecal fat de termination. Forty-five patients, 32 with ongoing diarrhea and 13 with out diarrhea, submitted stool samples. Twenty-two of 45 patients (49%) had qualitative or quantitative steatorrhea, 16/32 with diarrhea (50% ) and 6/13 patients without diarrhea (46%). Thirty of 32 patients with diarrhea had had extensive microbiologic and/or endoscopic evaluation s. Only 9 patients had a detectable intestinal pathogen, 5 patients ha d cytomegalovirus (4 treated), 4 patients had cryptosporidia (3 treate d), and 1 patient had microsporidia. Steatorrhea, as determined by abn ormal qualitative fecal fat, is detectable in nearly 50% of patients w ith HIV/AIDS. Fat malabsorption appears to be a primary defect in thes e patients independent of detectable pathogens. Assessment of fat mala bsorption should be considered in patients with unexplained weight los s or diarrhea before extensive evaluation for opportunistic infections .