icon-folder.gif   Conference Reports for NATAP  
  4th Intl Lipodystrophy Workshop
San Diego at Coronado Beach, Sept 22-25, 2002
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Treating Diarrhea in HIV
  Many individuals with HIV experience diarrhea which may or may not necessarily be completely drug-related. As we age with HIV gastrointestinal concerns start to emerge. As well, I suspect HIV may certainly affect the stomach as it does other organs. But very little HIV research is being conducted in this area. We have little understanding of the causes of diarrhea except when it is clearly drug related. Perhaps, as we age research into this area will gain importance. At this year's Lipodystrophy Wksp, there were 2 abstracts on treating diarrhea.
CR Heiser (abstract 59), from Indiana University, reported on the use of (Probiotics: acidophilus and bifido-bacteria), Metamucil, and L-Glutamine in treating nelfinavir-related diarrhea. Agouron was a co-author of the study. The study protocol was to administer acidophilus and bifidobacteria (Probiotics) 1.2 grams powder orally on an empty stomach in the morning, and 11 grams of soluble fiber supplement 2 hours after HAART so as not to int erfere with HAART absorption. If this did not work for a patienta after 4 weeks L-Glutamine was added, titrated up to 30 grams. 16 patients were randomized to the treatment group and 4 to a standard of care control group for 12 weeks.
In most patients nutritional interventions used in this study effectively controlled diarrhea associated with nelfinavir. Synergistic effects of the dietary component dramatically reduced diarhhea in 15 of 16 (94%) of study participants. Probiotics and soluble fiber (Metamucil) were associated with controlling diarrhea in 11 of 16 patients. Adding glutamine to the regimen further reduced diarrhea in the remaining 5 participants. Perception of side effects and quality of life measures were significantly improved in the treatment group. An exercise program was also instituted consisting of aerobic exercise (biking) and resistance exercise. Nutritional support by resolving diarrhea and exercise improved functional body composition outcomes: lean mass was significantly increased when estimated by the 7-site skinfolds, but not BIA, increased chest and shoulder circumfrances. There appeared to be a reduction in waist.
In a pilot study on diarrhea in HIV, bicarbonate-buffered pancrelipiase was administered to evaluate its effect on HAART-induced diarrhea (abstract 62). 15 HIV+ individuals experiencing HAART-induced diarrhea were enrolled in this blinded crossover study of two 7-day treatment periods (bicarbonate-buffered pancrelipase vs placebo). 11 patients completed the study while 4 patients were discontinued due to noncompliance.
The authors found that in the test tube (in vitro) 5 protease inhibitors (amprenavir solution and amprenavir capsules, ritonavir, nelfinavir, Kaletra, and saquinavir) caused a significant inhibition of lipase. This inhibition was reversed and lipase reactivated by the additionof pancrelipase. There was a significant difference in the consistency of the stools of the patients in the bicaronate buffered pancrelipase treatment as compared to the placebo (54% vs 28% of the stools were formed); however, there was no significant difference in stool frequency. The authors concluded that these study results justify the co-administration of bicaronate buffered pancrelipase with these protease inhibitors.