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Chronic Diarrhoea in AIDS Patients in the Tropics: A Review

Diarrhoea is a common clinical manifestation of human immunodeficiency virus type-l (HIV-1) infection both in developing and developed countries. In tropical countries chronic diarrhoea associated with significant weight loss ('slim disease') is often the presenting illness of HIV-l infected individuals1-3 • This diarrhoea-wasting syndrome in association with a positive HIV-l serology test is an AIDS-defining illness in the World Health Organization's classificatiorr'. Most clinical manifestations of HIV-l infection result either from the reactivation of preexisting latent pathogens as the individual becomes immunosuppressed or exposure to locally predominant pathogens. Consequently, clinical presentations of AIDS and the pathogens responsible in different geographical areas reflect the differing prevalence of endogenous infections. In this paper we summarize the data from studies of diarrhoea in HIV-l positive individuals in industrialized countries and review in detail studies of diarrhoea in HIV-1 positive patients in developing countries. We discuss the clinical manifestations and diagnosis of those diarrhoeal pathogens that have been newly recognized by the medical community since the advent of acquired immunodeficiency syndrome (AIDS), namely cryptosporidium, Isospora belli, and Microsporidium, and suggest an approach to the management of chronic diarrhoea in HIV-1 positive individuals in Africa.