HIV-related diarrhea is multifactorial and fat malabsorption is commonly present, independent of HAART

OBJECTIVE: Highly active antiretroviral therapy (HAART) has significantly d ecreased the incidence of infectious diarrhea affecting HIV-infected patien ts. Still, dial-rhea remains a common symptom in HIV. We sought to determin e the incidence of fat malabsorption as a cause of diarrhea in HIV patients receiving non-HAART (nucleoside analog only) and HAART (protease inhibitor -containing) antiretroviral regimens. METHODS: From June, 1995, to April, 1999, 88 HIV-infected patients underwen t evaluation for diarrhea, which included endoscopy. We examined the incide nce of fat malabsorption with a 24-h stool collection for fecal fat in a co hort of these patients (N = 33). Patients were divided into two groups, tho se receiving protease inhibitor-containing HAART and those receiving less i ntensive, nucleoside analog-only, non-HAART regimens. RESULTS: Thirty of 33 patients (90.9%) had fat malabsorption. Twenty of 21 patients not receiving HAART (95.2%) had fat malabsorption with a mean of 3 4 +/- 38 g of stool fat and a mean stool weight of 797 +/- 454 g. Ten of 12 patients receiving HAART (83.3%) had fat malabsorption with a mean of 46 /- 86 g of stool fat and a mean stool, weight of 800 +/- 647 g. Stool weigh t correlated with the degree of fat malabsorption (R = 0.77). CONCLUSION: Fat malabsorption represents a commonly undiagnosed entity in H IV-infected patients with diarrhea, whether or not they are receiving HAART therapy. Fecal fat determination should be considered a routine part of th e diagnostic workup of HIV-infected patients experiencing diarrhea. (C) 200 1 by Am. Cell. of Gastroenterology.