Diarrhea, in the context of human immunodeficiency virus (HIV) infection, is an enormously important clinical issue (Smith et al., 1988). Diarrhea in patients with AIDS is extremely problematic for both patient and clinician. More than 50% of AIDS patients suffer from diarrhea, the cause of which is unexplained in most of the cases. The causes of diarrhea in HIV infection are multifactorial. Chiefly, these may be caused by the primary retroviral infection per se, several opportunistic infections, alteration of gut microbiome, immune reconstitution, water sanitation or as a complication of highly active anti-retroviral therapy (HAART) like didanosine or ritonavir, and may also result from induced pancreatic insufficiency (Haas et al., 2011; Saha et al., 2011; Murray and Rubio-Tapia, 2012; Vyas et al., 2012; Agholi et al., 2013; Martin et al., 2013; Clay and Crutchley, 2014; Dye, 2014; Dikman et al., 2015; Green et al., 2015; Rubaihayo et al., 2015; Yates et al., 2015). The diarrhea in primary HIV infection is primarily secretory in nature (Juckett and Trivedi, 2011; MacArthur and DuPont, 2012). Some preliminary studies have suggested the role of viral proteins in causation and aggravation of diarrhea in HIV infected patients. For example, retroviral tat proteins have been demonstrated to enhance myenteric neuronal excitability by altering different sodium channels (Ngwainmbi et al., 2014). It is obvious that in HIV infection, a viral specific protein that affects genomic transcription would affect diverse cellular mechanism (s). This opinion piece advances a concept of how HIV may gain entry into the gastrointestinal mucosa using an upstream neuropeptide mechanism, providing a perspective of an incipient mechanism involved in mucosal disease caused by HIV and potential druggable targets for HIV induced diarrhea.