Dietary supplements can help with nelfinavir-related diarrhoea

While overall it remarkably improves both quantity and quality of life, highly active antiretroviral therapy (HAART) frequently involves side effects of some sort. These may be short-lived or persistent. In the case of nelfinavir the most annoying and nagging side effect has been diarrhoea.

Numerous treatments have been proposed for this side effect, and some actually work in some patients; however, despite these interventions many patients on nelfinavir continue to suffer from this side effect and its impact on their quality and enjoyment of life.

A study presented at the 1st IAS Conference evaluated whether dietary changes known to reduce diarrhoea in other conditions benefit patients with nelfinavir-induced diarrhoea. Twenty HIV-infected men on nelfinavir with diarrhoea participated in the 12-week prospective study. Sixteen received dietary supplements and 4 did not. The initial dietary supplements consisted of acidophilus/bifid bacteria (1.2 grams/day) and soluble fibre (11 grams/day), and, if diarrhoea persisted at week 4, 10 grams/day of L-glutamine was added and, if needed, increased up to 30 grams/day. Supplement dosing, tolerance, diarrhoea status and loperamide use were assessed monthly.

Weight, CD4+ T cells and viral load were unchanged in both groups after 12 weeks of dietary supplementation. Diarrhoea completely resolved in 9 of the 16 patients who received supplements, with the number of stools per day and incidence of diarrhoea significantly reduced. The patients in this group who did not obtain full relief with probiotics and fibre alone, still appeared to get some benefit from the supplements, with a significant decline in stools per day after starting L-glutamine and a significant decline in loperamide usage.

In the control group, the number of stools per day significantly increased and the incidence of diarrhoea remained unchanged. The use of loperamide in the control group remained stable. Finally, the dietary supplements were well tolerated and patients who received the dietary supplements felt that they improved their quality of life.

The authors conclude “Probiotics, soluble fibre and [L glutamine] significantly reduce diarrhoea for subjects receiving nelfinavir. Improvement was also seen in subjects who were not controlling diarrhoea with [loperamide] alone. Dietary methods to treat HIV diarrhoea are effective and clinically significant.”

This is helpful information, especially for patients who are having significant diarrhoea with nelfinavir but are unsuitable, due to resistance or intolerance, for a switch to another antiretroviral regimen. Similar findings were presented in another abstract presented at the IAS conference, which found that L glutamine supplementation (30 grams daily) alone was helpful in controlling nelfinavir- induced diarrhoea and improving overall quality of life.

C Heiser and others. Dietary supplementation with probiotics, soluble fibre and L-glutamine (GLN) reduces diarrhoea in HIV+ men receiving nelfinavir (NFV). Abstract 536. 1st IAS Conference on HIV Pathogenesis and Treatment. July 8-11, 2001. Buenos Aires, Argentina.

F Huffman and M Walgren. L-Glutamine Supplementation Improved Nelfinavir (NFV)-Associated Diarrhoea in HIV-Infected Individuals. Abstract 536. 1st IAS Conference on HIV Pathogenesis and Treatment. July-8-11, 2001. Buenos Aires, Argentina.