Management of protease inhibitor-associated diarrhea

Diarrhea is a common and often inadequately treated complication in patient s with human immunodeficiency virus infection. Diarrhea has a significant i mpact on quality of life (QOL) and can contribute to malnutrition, weight l oss, immunosuppression, and mortality In addition, diarrhea may have a sign ificant impact on compliance with antiretroviral therapy; however, this imp act has not been adequately assessed. Medications, including protease inhib itors (PIs), are recognized as a common cause of diarrhea. Treatment of PI- associated diarrhea is largely nonspecific; most of the available literatur e is published only in abstract form and is based primarily on retrospectiv e and survey data. Agents for which some efficacy has been shown for treatm ent of PI-associated diarrhea include oat bran, psyllium, loperamide, calci um carbonate, SP-303, and pancrelipase. Practitioners and patients need to work together to determine which treatment modality is appropriate based on efficacy, cost, and lifestyle. Management of diarrhea is crucial to improv ing QOL, controlling weight loss, and enhancing overall efficacy of antiret roviral therapy.