Selected highlights from the 4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
One of the side effects of protease inhibitor–based therapy can be diarrhea. If left untreated, diarrhea could, in theory, lead to wasting, tiredness and reduced quality of life. For protease inhibitor–related diarrhea, sometimes supplements of calcium (500 mg twice daily) or soluble fibre, such as Metamucil, have been reported to be helpful. For more details about this, see TreatmentUpdate 108
However, calcium supplements may not always work, so researchers in Chicago and Indiana tried a novel approach for treating diarrhea caused by the protease inhibitor nelfinavir (Viracept).
Researchers recruited 20 HIV positive men who used nelfinavir who had more than two liquid stools daily. They observed four subjects (the control group) while giving the remaining 16 the following:
First four weeks:
If after four weeks these products did not work, subjects could add the amino acid L-glutamine, starting at a dose of 10 grams/day to a maximum of 30 grams/day. L-glutamine soothes the intestines and helps them heal from inflammation. It is also used by the body to make the antioxidant glutathione, which is often deficient in PHAs. This supplement helps to increase muscle mass when used in conjunction with exercise. So perhaps it was not surprising that the study protocol included supervised exercise for 16 subjects.
Among the 16 subjects who received supplements, nine reported that their diarrhea cleared up within the first four weeks of the study, and six reported that gradually increasing the dose of L-glutamine helped reduce diarrhea from 2 ½ episodes daily to one episode daily. Diarrhea in one subject was unaffected by the supplements. Among the four control subjects who were not given any supplements, diarrhea continued.
REFERENCE
Heiser CR, French N, Russert MM, et al. Dietary supplementation and exercise reduces diarrhoea, increases muscular strength, and improves quality of life in HIV-positive men receiving nelfinavir. Abstract 59.
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