AIDS-Related diarrhea pathogenesis, evaluation and treatment

As the AIDS epidemic continues to spread and involve all segments of society, more and more internists and gastroenterologists are called upon to evaluate and treat patients with disabling diarrhea, the most common clinical manifestation of AIDS. It is often asked: Does it make sense to initiate an extensive workup if no specific etiologic agent is identified in many patients? Should we look for organisms when there is no specific therapy for many of them? We will try to answer both questions and outline a rational approach to the patient with AIDS-related diarrhea, on the basis of “small-bowel” versus “large-bowel” diarrhea and severity of symptoms. Isolation of one or more organisms is common if a proper search is conducted, and specific as well as symptomatic therapy can have a significant impact on the patient’s quality of life.