Your intestinal tract (gut) is about 25 feet long. It includes your stomach, small intestine, large intestine, rectum, and anus.

The gut is the body's largest immune organ, with the greatest number of immune cells. In fact, the lining of the gut contains 50 to 70 percent of your body’s lymphocytes (immune cells). The gut has two main functions:

• Digesting and absorbing nutrients
• Protecting you from infection

HIV can live in the lining of your gut. HIV itself, HIV-related conditions, and HIV medications can all cause problems in the gut. It is the site of many difficult-to-treat infections and hidden reservoirs (pockets) of HIV. All of this HIV activity can affect the intestinal lining and may lead to:

• Changes in your body’s ability to process food and drugs
• More stomach infections
• Diarrhea (sometimes severe)
• Weight loss

In addition, some AIDS-related opportunistic infections (OIs) occur in or affect the gut including:

• Cryptosporidiosis
• Microsporidiosis
• Cytomegalovirus (CMV)
• Mycobacterium avium complex (MAC)

Unfortunately, many HIV drugs can also cause problems that affect the gut such as:

• Diarrhea
• Nausea, vomiting, anorexia (loss of appetite)
• Pains
• Gas (flatulence)

The most common condition, diarrhea, can be very serious if not treated. Keeping your gut healthy can help you cope with and reduce side effects.

Diarrhea is one of the most common side effects of HIV, intestinal infections, and HIV drugs. Left untreated, it can cause dehydration (loss of water and nutrients).

You have diarrhea if you have watery stools or if you have three or more bowel movements each day. If your diarrhea lasts for more than a few days, contains blood, or if you have a high fever or stomach pain you should contact your doctor.

Your doctor should:

• Test your stool to see if you have a parasite, protozoa (microscopic organism), virus, or bacteria
• Check your blood for HIV-related infections, proteins, vitamins, and other important nutrients
• Use a microscope to look inside your gut (colonoscopy or endoscopy)

It can be difficult to diagnose the cause of diarrhea, but it is important to try since many infections will require treatment to be resolved.

If HIV drugs are causing your diarrhea you may be able to switch therapy. But that option is not for everyone and you should discuss it with your doctor before you stop or change any HIV drugs.

There are some medications (both over-the-counter and prescription) and supplements that can help manage diarrhea. These include:

• Over-the-counter remedies such as Imodium, Kaopectate, and Metamucil
• Harder-to-treat symptoms may need a prescription such as Lomotil
• Hormone therapy is being studied as a treatment for diarrhea
• Calcium, fiber, and glutamine (an amino acid) supplements

Diarrhea can seriously deplete your body’s water and vital nutrients (electrolytes). If the water is not replaced you will become dehydrated. Symptoms of dehydration include:

• Thirst, anxiety, weakness, confusion, lightheadedness, fainting
• Smaller amounts of urine
• Dry and pale skin
• Increased heart rate
• Decreased blood pressure

Try to drink before you feel dehydrated. Sports drinks can help to replenish electrolytes. You should seek medical attention if you are dehydrated.

Some foods cause diarrhea or make it worse including:

• Coffee and other beverages with caffeine (cola, some other soft drinks, tea, etc.)
• Alcohol
• Chocolate
• Fried, fatty, and spicy foods
• Hard to digest (insoluble) fiber such as raw vegetables, potato peels, beans, and brown rice
• Dairy products (milk and cheese)

Some foods can help to relieve diarrhea, such as the BRATT diet:

• Bananas
• Rice (white)
• Apple juice or apple sauce
• Toast
• Tea (herbal)

Nausea, vomiting, and anorexia (loss of appetite) often occur as side effects of starting or switching HIV drugs. For many people, nausea goes away by itself after a few weeks on the drugs. Other people require help from drugs called antiemetics (anti-nausea drugs).

Megace (a hormone) and Marinol (a synthetic version of marijuana) may also increase appetite. Marijuana may be effective for nausea and appetite loss but is not legal or available everywhere.

Nausea, vomiting, and anorexia can be particularly problematic for pregnant women who may be experiencing similar side effects because of their pregnancy (morning sickness).

Ways to cope with nausea include:

• Eating dry crackers
• Eating small meals more often
• Sticking to bland foods which are easier to digest
• Relaxing before meals and chewing slowly
• Sipping ginger tea or ginger ale

Gas (flatulence) and bloating can usually be managed by eliminating foods such as beans, broccoli, and vegetable skins. Over the counter or prescription drugs may also be used to relieve gas.

Heartburn (acid reflux) causes a burning sensation in your chest. It has nothing to do with your heart! It can happen when your stomach acid backs up into your esophagus. Try eliminating certain foods to avoid heartburn:

• Spicy or fatty foods
• Alcohol
• Caffeine
• Citrus juices (orange, grapefruit, lemon, and tomato)

If symptoms do not go away you should see your doctor.

Since HIV, other infections, and HIV drugs can cause many side effects that involve the gut, it is a good idea to keep your gut as healthy as you can.

• Keep your bowel movements regular: you can try over-the-counter products such as Citrucel or Metamucil
• Probiotics or "good" bacteria like lactobacillus (found in yogurt and acidophilus capsules) may help improve your intestinal environment
• Drink lots of water
• Eat high-fiber foods (whole grain rice, bread, oats, vegetables and fresh fruits)
• Cut down on caffeine, fried foods, sugar, and animal fat
• See your doctor on a regular basis and contact him or her if you are experiencing any gut-related symptoms

1		Highleyman, L. (2002). Managing Nausea, Vomiting, and Diarrhea. Bulletin of Experimental Treatments for AIDS. Retrieved December 2004 from http://www.aegis.com/pubs/beta/2002/BE020302.html
2		de Roos, N.M. and Katan, M.B. (2000). Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 1998. American Journal of Clinical Nutrition 71, 405-411. Retrieved December 2004 from http://www.ajcn.org/cgi/content/full/71/2/405