The churning action of the stomach breaks down food to help the absorption of nutrients in the small intestine. Malabsorption and diarrhea from intestinal problems are common in HIV and can result from both infectious and non-infectious causes.
Intestinal opportunistic infections are less frequent now than they were in the pre-HAART era, but people with advanced AIDS can develop Mycobacterium avium complex (MAC) or other bacterial infections of the small intestine. Cryptosporidium, a parasite which causes chronic diarrhea in people with AIDS, other parasites such as giardia and microsporidia, and some viruses can all infect the small intestine. Symptoms of small intestine infection often include upper abdominal cramping, bloating, and nausea, along with diarrhea. Stool and blood tests are necessary to check for infectious causes of diarrhea. When an infection can't be found, the diarrhea may be the result of small bowel bacterial overgrowth or HIV enteropathy -- the direct infection of the intestine with HIV. HIV enteropathy alters the lining of the small intestine, decreasing the area available to absorb nutrients. This condition may also affect drug absorption, although it's difficult to test the effects directly.
Infection in the large intestine has a distinct set of symptoms -- diarrhea with lower abdominal pain, defecating blood, or feeling the need to defecate but being unable to do so. The large intestine is a common site for infection with CMV, HSV, and bacteria like salmonella and shigella. Antibiotic therapy can alter the environment of the gut, allowing for overgrowth of the bacteria clostridium difficile in the large intestine, which causes diarrhea 3-4 times a day.
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