Joyce Anastasi

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Diarrhea affects more than 60% of persons living with HIV/AIDS. Diarrhea can be caused by pathogens, neoplastic diseases, side effects of medications, malabsorption, and/or enteropathy. Activities of daily living and quality of life are often affected by HIV/AIDS-related diarrhea. Traditional Chinese medical interventions such as acupuncture and moxibustion show promise in the area of gastrointestinal symptom management. The purposes of this study were to (a) determine the influence of acupuncture and moxibustion in reducing the frequency of diarrhea and increasing stool consistency in HIV-infected men with chronic diarrhea (defined as three or more episodes of watery, liquid, or loose stools in a 24-hour period for 3 weeks or more), (b) ascertain the feasibility of the methodology for a future prospective randomized controlled trial, and (c) determine sample size estimate for a prospective randomized controlled trial. Using a time-series design, 15 HIV-positive men with chronic diarrhea received the same acupuncture/moxibustion treatment for six sessions over a 3-week period. Each participant maintained a daily stool frequency/consistency and medication diary. All treatments were administered by a licensed acupuncturist trained in traditional Chinese medicine. Based on the intent to treat analysis comparing the change in stool frequency from baseline (Week 1) to Week 3 and Week 4, stool frequency reduced approximately one episode per day (Week 3: p < .001; Week 4: p < .005). Stool consistency also improved, from baseline to Week 3 and Week 4, by more than 1 point on Hansen's stool consistency scale. Acupuncture and moxibustion are promising modalities for the symptom management of chronic diarrhea in HIV/AIDS. The results of this pilot study also establish the feasibility of a larger study and provide the empirical basis to serve as preliminary data from which to estimate statistical power and sample size for a larger efficacy study, inclusive of women as well as men.

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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.

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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.

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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.

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