Macarthur Rodger D
WSU Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 4B, Detroit, MI. E-mail:
Am J Manag Care. 2013 Sep;19(12 Suppl):s238-45.
In geographic locations where highly active antiretroviral therapy (HAART) is widely available, the nature of HIV-related diarrhea has shifted from being predominantly a consequence of opportunistic infection to being largely a side effect of HAART agents. With this shift has come a smaller risk for the life-threatening wasting and weight loss, although serious instances of noninfectious diarrhea remain a concern. While estimates vary, in part due to the lack of a standard diarrhea definition, over a quarter of patients receiving HAART experience diarrhea. The negative effect on quality-of-life in patients with HAART-related diarrhea is profound; diarrhea may also increase the risk of poor adherence to treatment, with potentially serious effects on viral suppression and increased risk of drug resistance. Diagnosis of HAART-related diarrhea largely involves ruling out pathogen involvement, which, in addition to laboratory testing, may require endoscopic examination. Treatment was, until recently, mainly supportive in nature. The recent US Food and Drug Administration approval of crofelemer offers the first reliably effective treatment for HAART-related diarrhea.
在高效抗逆转录病毒疗法（HAART）广泛可得的地理位置，与HIV相关的腹泻的性质已从主要是机会性感染的后果转变为很大程度上是HAART药物的副作用。随着这种转变，危及生命的消瘦和体重减轻的风险降低了，尽管严重的非感染性腹泻病例仍然令人担忧。尽管估计数字各不相同，部分原因是缺乏标准的腹泻定义，但超过四分之一接受HAART治疗的患者会出现腹泻。HAART相关腹泻对患者生活质量的负面影响是深远的；腹泻还可能增加治疗依从性差的风险，对病毒抑制产生潜在严重影响，并增加耐药风险。HAART相关腹泻的诊断主要涉及排除病原体感染，这除了实验室检测外，可能还需要内镜检查。直到最近，治疗在很大程度上主要是支持性的。美国食品药品监督管理局最近批准了克罗felemer，这为HAART相关腹泻提供了首个可靠有效的治疗方法。
