health lab by pravin chaturvedi, phd
SUFFERING IN SILENCE
Many PLWHA continue to suffer in silence as they live with chronic
diarrhea, often for several years. This does not need to be the case.”
than one month). The recent survey found that 79 percent of the respondents with diarrhea stated that they have had diarrhea for more than one year. More shockingly, 61 percent of the respondents said that they have had diarrhea for more than five years. Because the more well-known remedies often do not provide long-term relief, doctors tell patients that “this can happen with HIV” or recommend they change their diet. The survey results also found that 30 percent of the respondents stated that they either never discussed diarrhea with their doctor, or that their doctor “blew off” their issue with diarrhea. In fact, only one-half (52 percent) of the respondents said that any sort of treatment was recommended to them by their doctor. This may be because they are not aware of the newest available treatment for HIV-related diarrhea. Doctors and PLWHA should know that there
is a first-in-class antidiarrheal drug approved by the United States Food and Drug Administration (FDA) for the symptomatic relief of noninfectious diarrhea in HIV/AIDS patients receiving antiret- roviral therapy (ART). That drug is called Mytesi (crofelemer) and is available by prescription. It is the only drug studied in PLWHA on ART, and has been proven safe and effective over a six-month treatment period. Information for this prescription drug is available at
mytesi.com.
For people living with HIV and AIDS
(PLWHA), frequent doctor visits throughout the year are not uncommon. During these visits, it typically starts off with a doctor or nurse running through a list of standard questions, asking patients about general symptoms and any new symptoms. However, there is a major item missing from this discussion: Diarrhea.
Why does this matter? Diarrhea remains an under reported and problematic issue in PLWHA. In a recent survey of PLWHA , 27 percent of the respondents stated that they currently had diarrhea and 56 percent of the respondents mentioned that they have had diarrhea in the past. However, while 72 percent said their doctor asks about symptoms during a typical office visit, only 31 percent said their doctors asked about diarrhea, without them bringing it up first. In PLWHA, chronic diarrhea (which is diarrhea
that lasts for more than one month) can be due to the side effects of antiretroviral therapy (ART) or the direct effect of HIV on the gastrointestinal (GI) tract, collectively referred to as HIV-related diar-
rhea. Chronic HIV-related diarrhea has a profound effect on the lives of these PLWHA as they have to plan around their diarrhea. For many PLWHA, diarrhea may not be something they are comfortable bringing up on their own with their doctor, so they attempt to self-treat with over-the-counter (OTC) products such as Imodium or Pepto-Bismol, which have not been proven effective in HIV-related diarrhea. And, the survey of PLWHA showed that if they do have a discussion about diarrhea with their doctor, the recommendation is most often to take Imodium or an older prescription treatment called Lomotil or to add fiber to their diet, which they may already have tried. Imodium and Lomotil are opioids that work as anti-motility, agents, which slow the GI tract and can result in constipation, which many find to be just as bad as the diarrhea. After a while, because the diarrhea continues
to affect their lives, many PLWHA living with diarrhea “accept” their condition and no longer bring it up with their doctor, because they assume there is nothing else that can be done. Diarrhea in PLWHA is often chronic, (lasts longer
Only one percent of the respondents in this survey reported that they had been told about Mytesi by their doctor. Many PLWHA continue to suffer in silence as they live with chronic diarrhea, often for several years. This does not need to be the case. PLWHA and suffering from diarrhea are encour- aged to speak with their doctors and stop suffering in silence with diarrhea. Mytesi is not approved to treat infectious diarrhea (diarrhea caused by bacteria, a virus, or a parasite). Before starting you on Mytesi, your healthcare provider will first be sure that you do not have infec- tious diarrhea. Otherwise, there is a risk you would not receive the right medicine and your infection could get worse. In clinical studies, the most common side effects that occurred more often than with placebo were upper respiratory tract (sinus, nose, and throat) infection (5.7 percent), bronchitis (3.9 percent), cough (3.5 percent), flatulence (3.1 percent), and increased bilirubin (3.1 percent).
Pravin Chaturvedi, PhD is chairman of the Scientific Advisory Board for Napo Pharmaceuticals.
FEBRUARY 2018 | RAGE monthly 37
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