Global Impact of Antiretroviral Therapy-Associated Diarrhea

Abstract

Dear Editor, Side effects of antiretroviral therapy (ART) still remain a formidable issue for patients globally. In resource-limited settings, side effects are a major risk for lack of treatment adherence. 1 Diarrhea remains one of the leading side effects seen in ART, and it contributes significantly to lack of treatment adherence in patients experiencing it. 2 Historically, diarrhea in HIV-positive patients was due to opportunistic infections or HIV itself. 3 However, since the advent of highly active antiretroviral therapy (HAART), diarrhea is now thought to be primarily due to antiretrovirals. 4 It is noted that among the major classes of antiretrovirals, protease inhibitors (and in particular ritonavir) seem to carry the greatest risk of for ART-induced diarrhea. 5 Two recent reviews highlight the importance of ART-associated diarrhea in HIV-infected patients, and focus on data regarding ritonavir-associated diarrhea. Macarthur and DuPont 6 found that up to 18% (range, 2‐18%) of patients on ritonavir-boosted protease inhibitor regimensexperiencegrade2‐4diarrhea(grade1 =mild;grade 2 =moderate; grade 3 =severe; grade 4 =life threatening). Wegzyn et al. 7 reported a diarrhea incidence of 15.5% in patients taking ritonavir-boosted lopinavir as part of their ART. These results mimic a previous review that demonstrated up to 19% (range, 2‐19%) of patients experience diarrhea on similar regimens. 2 Given that none of the current re