Does HIV Cause Diarrhea?

Medically reviewed by Thomas Dean Chiampas, PharmD, BCPS, AAHIVP on October 9, 2017Written by Kristeen Cherney on October 27, 2015

A common problem

Human immunodeficiency virus (HIV) compromises your immune system and may cause opportunistic infections that bring many symptoms. You can also experience a variety of symptoms when you become infected with HIV. Some of these symptoms, like diarrhea, may even occur because of treatment.

Diarrhea is one of the most common complications of HIV. It can be severe, casing occasional loose stools, and it can also be ongoing (chronic). Identifying the cause of diarrhea in HIV infection can help you get the right treatments for long-term management and better quality of life.

Causes of diarrhea in HIV

Diarrhea in HIV has many possible causes. Diarrhea can be an early symptom of HIV, also known as acute HIV infection. According to the Mayo Clinic, HIV produces flu-like symptoms within two months of infection. You may continue to experience the symptoms, including diarrhea, for a few weeks. Other symptoms of acute HIV infection include:

  • fever or chills
  • nausea
  • night sweats
  • muscle aches or joint pain
  • headaches
  • sore throat
  • rashes
  • swollen lymph nodes

These symptoms are like those of seasonal flu. The difference is that you may still have symptoms even after taking over-the-counter flu medications. Untreated diarrhea is especially dangerous. It can lead to dehydration or other life-threatening complications.

An initial infection isn’t the only cause of diarrhea in HIV. It’s also a common side effect of HIV medications. Along with diarrhea, you might experience other side effects like nausea or abdominal pain.

Antiretroviral (ARV) medications carry a risk of diarrhea, but some classes of ARVs are more likely to cause diarrhea. The class with the greatest chance of causing diarrhea is known as the protease inhibitor (PI) class. Diarrhea is more often associated with older PIs like lopinavir/ritonavir (Kaletra) and fosamprenavir (Lexiva), than newer PIs like darunavir (Prezista) and atazanavir (Reyataz). Tell your doctor if you’re taking an ARV and experience lasting diarrhea.

Gastrointestinal (GI) problems are common in people with HIV. Diarrhea is the most common GI symptom, according to the University of California, San Francisco (UCSF). HIV-related GI issues that can lead to diarrhea include:

Intestinal infections

According to UCSF, some infections are unique to HIV, like Mycobacterium avium complex (MAC). Others, such as Cryptosporidium, cause limited diarrhea in people without HIV, but may be chronic in people with HIV. In the past, diarrhea from HIV was more likely to be caused by infection. But diarrhea that’s not caused by infection has become more common.

Bacterial overgrowth

Small bacterial overgrowth is possible in people with HIV. Intestinal problems may make a person with HIV more likely to have an overgrowth of bacteria. This may lead to diarrhea and other digestive issues.

HIV enteropathy

HIV itself may be a pathogen that causes diarrhea. According to the National Center for Biotechnology Information (NCBI), a person with HIV who has diarrhea for more than a month is diagnosed with HIV enteropathy when no other cause is found.

Treatment options

If diarrhea remains a persistent problem while taking anti-HIV drugs, your doctor may prescribe a different type of medication. Don’t stop taking your medication unless directed by a doctor. If you don’t stick with your HIV medication regimen, the virus may start to replicate faster in your body. Faster replication can lead to mutated copies of the virus, which can lead to medication resistance.

Scientists have worked to create medications to ease diarrhea. Crofelemer (formerly known as Fulyzaq, but now has the brand name Mytesi) is an antidiarrheal prescription medication for treating noninfectious diarrhea. In 2012, the U.S. Food and Drug Administration (FDA) approved crofelemer to treat diarrhea caused by anti-HIV medications.

Diarrhea may also be treated with home remedies and lifestyle changes. You may try to:

  • drink more clear liquids
  • avoid caffeine
  • refrain from consuming milk products
  • eat 20 grams or more of soluble fiber per day
  • avoid greasy, spicy foods

If there is an underlying infection causing diarrhea, your doctor will work to treat it. Do not start taking any medication to stop diarrhea without first talking to your doctor.

Seeking help

Addressing HIV-related diarrhea is important for quality of life and comfort. But it’s important to remember that chronic diarrhea is dangerous and should be treated as soon as possible. You should call a doctor right away if you have bloody diarrhea or if you have a fever at the same time.

How long does it last?

The prevalence of diarrhea in HIV depends on its cause. You might only experience diarrhea as part of an acute infection syndrome. And you might notice fewer episodes after a few weeks.

Diarrhea may clear up after switching to medications that often don’t cause this side effect. You may also experience immediate relief by making certain lifestyle changes or taking medications prescribed to treat diarrhea. But don’t start taking any medications to stop diarrhea without first talking to your doctor.

A bigger problem may be malnutrition. People with chronic HIV who are malnourished may experience worsened diarrhea. This issue is more common in developing nations where malnutrition is a problem for people with and without HIV. One study published by the journal HIV/AIDS estimated that 100 percent of all people with HIV in developing regions have chronic diarrhea.

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