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Prevalence and Impact of Diarrhea on Health-related Quality of Life in HIV-infected Patients in the Era of Highly Active Antiretroviral Therapy

Siddiqui, Uzma, MD; Bini, Edmund J., MD, MPH; Chandarana, Khushbu, MD; Leong, Jennifer, MD; Ramsetty, Sabena, MD; Schiliro, Danise, MD; Poles, Michael, MD, PhD

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 484-490
doi: 10.1097/01.mcg.0000225694.46874.fc
Alimentary Tract: Clinical Research
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Objectives Before the introduction of highly active antiretroviral therapy (HAART), the majority of HIV-infected patients experienced diarrhea. The aims of this study were to compare the prevalence of diarrhea among HIV-infected and uninfected patients in the HAART era, and to evaluate the impact of diarrhea on health-related quality of life (HRQOL).

Methods Diarrheal symptoms experienced by 163 consecutive HIV-infected patients and 253 HIV-seronegative control subjects were ascertained using a validated questionnaire. The HRQOL of these patients was assessed using the Medical Outcomes Study (MOS) SF-36 and MOS-HIV Health surveys.

Results Among the 163 HIV-infected patients, the median CD4 cell count was 370 cells/mm3 and 150 individuals were taking HAART. Significantly, more HIV-infected subjects reported having 3 or more bowel movements daily within the past 7 days than did HIV-seronegative subjects (28.2% vs. 7.1%, P<0.001), even after adjusting for potential confounding variables (odds ratios=6.65; 95% confidence intervals, 3.36-13.17). In addition, diarrhea was significantly more common in HIV-infected patients than in control subjects when assessed by several other criteria. HIV-infected patients reported significantly worse HRQOL across all domains of the MOS SF-36 as compared with control subjects. Among HIV-infected patients, individuals with diarrhea had significantly worse HRQOL in nearly all domains of the MOS-HIV as compared with those without diarrhea.

Conclusions Diarrhea remains an important clinical problem in HIV-infected patients and is associated with significant impairments in HRQOL. It is important that healthcare providers specifically evaluate their HIV-infected patients for diarrhea so that these symptoms may be optimally managed.

Division of Gastroenterology, VA New York Harbor Healthcare System, Bellevue Hospital, and NYU School of Medicine, New York, NY

Reprints: Uzma D. Siddiqui, MD, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520 (e-mail: uzma.siddiqui@yale.edu).

Received for publication April 6, 2006; accepted September 13, 2006

© 2007 Lippincott Williams & Wilkins, Inc.