EFFECT OF LACTOSE INGESTION ON THE DIARRHEA OF HIV+ PATIENTS WITH DIARRHEA

JM Tinmouth¹, S Walmsley¹, G Tomlinson², AH Steinhart¹, GP Kandel¹

Department of ¹Medicine, Department of ²Medical Imaging, University of Toronto, Toronto, Ontario

INTRODUCTION: Even in the current era of highly active antiretroviral therapy (HAART), diarrhea in HIV remains a common problem. Pilot data suggests that a majority of practitioners recommend avoidance of dairy products to their HIV+ patients with diarrhea even though its value is not proven. The purpose of this study was to determine the effect of lactose ingestion on HIV+ patients with diarrhea.

METHODS: Randomized, double-blind, crossover trial of HIV+ patients with at least 3 loose to watery bowel movements per day for 4 weeks or who require daily anti-diarrhea medications. Patients underwent lactose and placebo study periods in random order and ingested 240mL of either low fat milk (12g lactose) or lactose-free milk. An 8 hr. stool collection was performed with a concurrent hydrogen breath test (HBT). Symptom score questionnaires were completed. The primary outcome was the difference in stool weights after ingestion of lactose-containing milk and of lactose-free milk for the entire sample.

RESULTS: Twenty male patients with a median age of 41 were studied. Median CD4 and viral load were 345 (20-960) and 462 (undetectable-114,872) respectively. Eighty percent were on HAART and the median number of BMs/day was 5 (2-12). Dairy product avoidance was reported by 25%. Thirty percent were lactase deficient (LD) by HBT. For the entire sample, the mean difference in stool weights between the lactose and placebo periods was -43.3g (95% C.I.: -125.3g to 17.2g). For LD patients, the mean difference in stool weights between study periods was 41.5g (95% C.I.: -14.1g to 97.8g). Difference in symptom score was not significant between the two periods.

CONCLUSION: While a significant proportion of patients were LD, stool output and symptoms were not significantly improved during the lactose free (placebo) study period. Lactose avoidance is unlikely to be of benefit in HIV-related diarrhea.

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