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Bile acid malabsorption in HIV infected patients with chronic diarrhoea |
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| Authors: | M E Cramp M C Hing D J Marriott J Freund D A Cooper |
| Institution: | Clinical Research Fellow, Institute of Liver Studies, Ring's College Hospital, School of Medicine and Dentistry, London, UK.;Associate Visiting Medical Officer, Bruce Hall Department of Gastroenterology, St Vincent's Hospital, Sydney, NSW.;Staff Specialist in Infectious Diseases and Microbiology, St Vincent's Hospital, Sydney, NSW.;Director, Department of Nuclear Medicine, St Vincent's Hospital, Sydney, NSW.;Professor of Medicine, Director, HIV Medicine Unit, St Vincent's Hospital, Sydney;Director, National Centre in HIV Epidemiology and Clinical Research, Victoria Street, Sydney, NSW. |
| Abstract: | Aims: To look for the presence of bile acid malabsorption in HIV infected patients with chronic diarrhoea and determine whether bile sequestering agents may have a role in palliating this common problem. Methods: Nineteen HIV infected patients with chronic diarrhoea (duration >one month) poorly controlled on conventional treatment were investigated using the seven day retention of Results: Sixteen (84%) had evidence of bile acid malabsorption (<15% retention at seven days). Ten of the 16 patients with bile acid malabsorption had terminal ileal biopsies -six had ileitis and four normal histology, suggesting that malabsorption is not always related to terminal ileitis. Thirteen patients with bile acid malabsorption have been treated with cholestyramine and 11 have reported a symptomatic response. Conclusions: Bile acid malabsorption can be demonstrated in some cases of HIV associated chronic diarrhoea and we suggest a therapeutic trial of a bile sequestering agent in patients whose symptoms are not well controlled using conventional anti-diarrhoeal agents. |
| Keywords: | Diarrhoea HIV infection bile acid malabsorption SeHCAT test |