Joyce Anastasi

Abstract

With the advancement of the therapeutic management of the human immunodeficiency virus (HIV), changes in the manifestation and clinical presentation of the disease are also evident. Clinicians and patients are continually challenged by these changes because frequently they are the first individuals to encounter them. Thus, clinical questions raised by clinicians/practitioners can often guide the endeavor of researchers. In this summation, the authors, a research scientist and clinician, highlight the main themes of the current state of the science of diarrhea and wasting presented at the 12th Annual Association for Nurses in AIDS Care conference. The experiences of both authors will hopefully provide greater insight into the current state of diarrhea and wasting in HIV.

Abstract

This article highlights the primary causes of HIV-related diarrhea. This article also reviews and evaluates available stool outcome measures frequently used in gastrointestinal studies examining fecal outcomes. Discussion focuses on instruments, scales, and other quantitative measures to assess stool outcomes. A discussion of the advantages and limitations of each instrument is included.

Abstract

Background: This study reflects an attempt to identify the causes of diarrheal illness in hospitalized HIV patients in light of therapeutic advancements in HIV management. Methods: The study identifies the various etiologies associated with diarrhea among HIV patients hospitalized in New York State in 1998. Data for this study were extracted from the New York State Department of Health Statewide Planning and Research Cooperative System. Pathogens recognized to cause diarrhea in persons with HIV and general codes identifying diarrhea were examined by using the principal and all secondary diagnoses based on the International Classification of Diseases 9th Revision Clinical Modification codes. Results: Based on the Statewide Planning and Research Cooperative System data set, more than 15,000 patients with HIV were hospitalized in 1998. Among the HIV patients hospitalized, 2.8% were admitted with a diarrheal diagnosis. The following diagnoses occurred the most frequently among HIV patients hospitalized with a diarrheal illness: Clostridium difficile (51.3%), other protozoal diseases (18.1%), and other organisms, not elsewhere specified (11.7%). Conclusions: In the era of highly active antiretroviral therapy, diarrhea is still an occurring symptom in HIV patients. Despite the relatively small percentage of hospitalizations attributed to diarrhea, clinicians must remember that even 'mild' to 'moderate' diarrhea can have a debilitating impact among persons with the symptom.

Abstract

Sixty percent of patients with human immunodeficiency virus (HIV) in the United States and 90% throughout the world will have diarrhea at some point in their illness. This article provides an introductory exploration and discussion of Western and Eastern perspectives of chronic diarrhea in patients with HIV. Western etiologies and treatment approaches, as well as Eastern views from traditional Chinese medicine pathogenesis and treatment principles involving acupuncture and moxibustion are presented. Whereas their interpretations of the causes of diarrhea are different, both the East and West have something to offer patients with this distressing symptom. Further exploration and clinical research is needed in this area.