Antimotility agents for chronic diarrhoea in people with HIV/AIDS
Editorial Group: Cochrane HIV/AIDS Group
Published Online: 8 OCT 2008
Assessed as up-to-date: 13 SEP 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Nwachukwu CE, Okebe JU. Antimotility agents for chronic diarrhoea in people with HIV/AIDS. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD005644. DOI: 10.1002/14651858.CD005644.pub2.
- Publication Status: New
- Published Online: 8 OCT 2008
AIDS-related diarrhoea is a common cause of morbidity and mortality in HIV positive individuals, especially in the sub-Saharan Africa where 70% of deaths from HIV occur. It often compromises quality of life both in those receiving antiretroviral therapy (ART) and the ART naive. Empirical antidiarrhoeal treatment may be required in about 50% of cases which are non-pathogenic or idiopathic and in cases resulting from antiretroviral therapy. Antimotility agents (Loperamide, Diphenoxylate, Codeine) and adsorbents (Bismuth Subsalicylate, Kaolin/Pectin, Attapulgite) are readily available, and have been found to be useful in this condition and so, are often used. Antimotilitics are opioids, decreasing stool output by reducing bowel activity thereby increasing fecal transit time in the gut, promoting fluid and electrolyte retention while adsorbents act by binding to fluids, toxins and other substances to improve stool consistency and eliminate the toxins. Due to its potential impact on the management of chronic diarrhoea in persons with HIV/AIDS, we reviewed the effectiveness of antimotility agents in controlling chronic diarrhoea in immunocompromised states caused by HIV/AIDS.
To assess the effectiveness of antimotility agents in controlling chronic diarrhoea in people with HIV/AIDS.
We searched Medline, EMBASE, the Cochrane Controlled Trials Register, the Cochrane HIV/AIDS Register and AIDSearch databases in November 2006. We also contacted WHO, CDC, pharmaceutical companies and experts in the field for information on previous or on-going trials and checked reference list from retrieved studies, irrespective of language and publication status.
Randomised controlled trials comparing an antimotility agent or an adsorbent with another antimotility agent, placebo, an adsorbent or no treatment in children and adults diagnosed with HIV and presenting with diarrhoea of three or more weeks duration.
Data collection and analysis
Two authors independently undertook study selection and examined full articles of potentially eligible studies.
One trial was found assessing the use of an adsorbent (attapulgite) compared to a placebo for chronic diarrhoea in people with HIV/AIDS. It included 91 adults (Aged 18 to 60), diagnosed with AIDS and experiencing diarrhoea for at least 7 days. There was no evidence that attapulgite is superior to placebo in controlling diarrhoea by reducing stool frequency and normalising stool consistency on days 1 (0.34 (95% CI 0.01 - 8.15)), 3 (1.35 (95% CI 0.51 - 3.62)) and 5 (1.74 (95% CI 0.89 - 3.38)). This was a small trial and may not have had enough power to show evidence of effects. Five deaths were reported which was not classified according to the arms of the study.
Studies assessing the use of antimotility agents were not found.
This review highlights the absence of evidence for the use of antimotility agents and adsorbents in controlling diarrhoea in people with HIV/AIDS. While no trials assessing the use of Antimotilitics were found, the retrieved study showed that attapulgite was not better than placebo in controlling diarrhoea in HIV/AIDS patients . For optimum patient care, these agents can still be used, with greater emphasis placed on adjunct therapies like massive fluid replacement while evidence for practice is awaited from further studies and reviews.
Plain language summary
Use of antimotility drugs (Loperamide, Diphenoxylate, Codeine) to control prolonged diarrhoea in people with HIV/AIDS.
People with HIV/AIDS often develop prolonged diarrhoea which are sometimes not caused by infections. This is more so in the sub-Saharan Africa where drugs for controlling HIV itself i.e. antiretroviral drugs (ARV) may not be widely available or affordable. prolonged diarrhoea often results in prolonged illness and death due to loss of fluids, if not treated effectively and on time. Antimotility drugs and adsorbents are readily available and are used to try to control this condition while efforts are made to receive ARVs. We did not find enough evidence to support or refute their use in controlling this condition.
與愛滋病相關的腹瀉,是人類後天免疫不全病毒呈陽性反應的人們常見的產生併發症及致死之原因，特別是在南撒哈拉沙漠地區,有70%死亡原因是後天免疫不全病毒造成。 它常常會損及無論有無接受抗轉錄病毒療法之患者的生活品質。約50%的非病原性，不明原因或因抗轉錄病毒療法造成腹瀉之病人可能需要經驗性止瀉治療。 抗蠕動藥物(Loperamide, Diphenoxylate, Codeine)和吸附劑(Bismuth Subsalicylate, Kaolin/Pectin, Attapulgite)都是容易取得,已被發現對於這些情況有所幫助且經常被使用. 抗蠕動藥物類似嗎啡,藉由減少腸道活動使得糞便於腸道暫存時間增加,進而減少糞便排出,促進液體及電解質的留存,而吸附劑為藉由與液體,毒素及其他物質結合增加糞便的黏稠度以及移除毒素,由於它對於慢性腹瀉在人類後天免疫不全病毒感染者/愛滋病患者之可能影響,我們回顧了抗蠕動藥物於控制人類後天免疫不全病毒感染者/愛滋病患者之慢性腹瀉的效果
我們在2006年11月搜尋Medline, EMBASE, the Cochrane Controlled Trials Register, the Cochrane HIV/AIDS Register及AIDSearch databases等資料庫. 我們也和世界衛生組織(WHO),疾病管制局(CDC), 製藥公司及相關領域之專家聯繫以取得先前或正在進行中的臨床試驗資訊並從取得的研究確認參考資料清單,無論其語言或發行情況.
發現有一個試驗,對於慢性腹瀉在人類後天免疫不全病毒感染者/愛滋病患者,評估使用一個吸附劑(attapulgite)與安慰劑相互比較,收集了診斷有愛滋病且經歷至少七天腹瀉的91位成人(18 – 60歲).並沒有任何證據顯示在第1,3,5天, attapulgite比安慰劑在控制腹瀉之降低解便頻率及糞便濃稠正常化方面有比較好.第一天0.34 (95% CI 0.01 8.15), 第三天1.35 (95% CI 0.51 3.62),第五天1.74 (95% CI 0.89 3.38).這是一個小型的試驗並且可能不具有足夠的效力去證明是否有效果.另外有五名死亡病例報告,但是根據這個研究的設計並未被分類.沒有發現關於評估抗蠕動藥物的使用之研究.
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
使用抗蠕動藥物(Loperamide, Diphenoxylate, Codeine)於控制人類後天免疫不全病毒感染者/愛滋病患者之慢性腹瀉: 人類後天免疫不全病毒感染者/愛滋病患者常會產生有時是非感染造成之過長時間的腹瀉.這種情況在非洲的南撒哈拉沙漠是更為嚴重,在當地,控制人類後天免疫不全病毒本身的藥物(如抗轉錄病毒藥物)並不易取得或足以支付其費用.過長時間的腹瀉時常因水分的流失而未有有效且及時的治療,造成過長的病態與死亡.抗蠕動藥物容易取得,並且再努力爭取抗轉錄病毒的治療時,使用以試著控制這種情形. 我們並未發現有足夠的證據去支持或駁斥使用他們來控制這些情況.