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• W2296220455 abstract "Chronic diarrhea is one of the disabling symptoms in 50% of patients with human immunodeficiency virus (HIV) infection. Although infection and malignancy of the gastrointestinal (GI) tract may be associated with some cases of chronic diarrhea in HIV-infected patients the specific cause of the diarrhea remains unknown in a large proportion of cases. Treatment is primarily symptomatic and we chose to investigate dioctahedral smectite (DS) a natural nonsystemic specific aluminosilicate. In various animal models DS was found to protect intestinal mucosa against enteropathogenic lesion-causing viruses as detected by scanning electronic microscopy. DS has been used successfully as a symptomatic treatment for acute diarrhea in children and adults and was therefore a natural choice for our study of chronic diarrhea in HIV-infected individuals. 6 male Thai adults seropositive for HIV and presenting with persistent diarrhea were the subjects of this open study. Their ages ranged from 26-56 years mean of 36.2 +or- 11.4 years. 4 of the subjects were diagnosed with acquired immune deficiency syndrome (AIDS) and 2 with AIDS-related complex (ARC). The patients had experienced diarrhea for durations of 10-90 days (mean of 39 days). The majority had 4-6 watery stools/day; none had bloody mucous diarrhea. The mean CD4 count of the 6 patients was 178 +or- 113/cu.mm with the highest values in the 2 ARC patients (280 and 342/cu.mm). 2 patients were receiving concurrent antibiotics; 1 for staphylococcal endocarditis and 1 for secondary prophylaxis for Pneumocystis pneumonia (cotrimoxazole). No enteric pathogens were identified in any patient either by stool culture modified acid fast stain of the stool or repeated ova and parasite testing. No viral or mycobacterial stool culture was performed nor was any sigmoidoscopy or colonoscopy. A fixed dose of DS (Smecta Ipsen France) was given to each patient: 2 3-gm DS sachets 3 times daily for 3 days followed by 1 sachet 4 times daily for 4 days. The drug was discontinued after 7 days and the recurrence of diarrhea was followed until discharge. In all patients diarrhea improved within 5 days of treatment returning to 1-2 bowel movements/day with firm or semisolid stool. Improvement was noted sooner for the diminished frequency of diarrhea than in stool consistency. No recurrence of diarrhea was observed during a 39-day followup period. No significant side effects were observed except for 1 patient who developed nausea and abdominal distension during the treatment period which subsequently resolved upon cessation of therapy. Our limited experience with DS in idiopathic chronic diarrhea in HIV-infected patients indicates both efficacy and tolerance. Our study warrants a larger scale double-blind placebo-controlled clinical trial of DS in HIV-associated diarrhea. (full text) (5 references cited in original document)" @default.
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• W2296220455 date "1992-01-01" @default.
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• W2296220455 title "Smectite in HIV-associated diarrhea: a preliminary study [letter]" @default.
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