Katabira E T
Department of Medicine, Makerere Medical School, Kampala, Uganda.
Int J Infect Dis. 1999 Spring;3(3):164-7. doi: 10.1016/s1201-9712(99)90040-1.
Diarrhea is the most common gastrointestinal symptom in human immunodeficiency virus (HIV) infection. It affects up to 90% of patients, becoming more frequent and severe as the immune system deteriorates. It often is associated with significant morbidity and mortality particularly in the developing countries. Gastrointestinal infections, some of which are attributable to inadequate sanitation and poor hygiene are the predominant cause of diarrhea, although multiple medications, including traditional herbs, also may be causes. The basic principles of management include detection of treatable causes, relief of symptoms, prevention of malnutrition, and psychosocial support. In up to 60% of cases, no cause can be identified, partly because of inadequate investigative facilities. Symptomatic treatment is the mainstay of management particularly when no cause can be identified. Unfortunately this can be extremely difficult when the patient is severely immune-suppressed. There is poor response to motility control drugs, such as loperamide, and others, such as octreotide, are too expensive. Fluid replacement should be started early to prevent excessive dehydration. This should be combined with nutritional support to prevent malnutrition. Psychosocial support, including counselling, for both the patient and the caring relatives, is required to alleviate anxiety, particularly when the diarrhea becomes intractable.
腹泻是人类免疫缺陷病毒（HIV）感染中最常见的胃肠道症状。高达90%的患者会受到影响，随着免疫系统恶化，腹泻会变得更加频繁和严重。腹泻往往与显著的发病率和死亡率相关，尤其是在发展中国家。胃肠道感染是腹泻的主要原因，其中一些可归因于卫生设施不足和卫生习惯不良，不过多种药物，包括传统草药，也可能是病因。治疗的基本原则包括查明可治疗的病因、缓解症状、预防营养不良以及提供心理社会支持。在多达60%的病例中，无法查明病因，部分原因是调查设施不足。对症治疗是治疗的主要手段，尤其是在无法查明病因时。不幸的是，当患者免疫严重抑制时，这可能极其困难。对动力控制药物（如洛哌丁胺）反应不佳，而其他药物（如奥曲肽）则过于昂贵。应尽早开始补液以防止过度脱水。这应与营养支持相结合以预防营养不良。需要为患者及其护理亲属提供心理社会支持，包括咨询，以减轻焦虑，尤其是当腹泻变得难以治疗时。
