to medications. HIV infection complicated by the opportunistic infections that were causes of debilitating diarrhea in the era prior to combination antiretroviral therapy are now relatively rare as a result of this therapy. Now the more common cause of diarrhea is adverse reactions to medicines, which show variable rates depending on the drug.

Severe cases of diarrhea can lead to dehydration and malnutrition, and have been found to significantly reduce quality of life in areas such as physical functioning, social functioning, and fatigue (Siddiqui et al., 2007). The Nutrition for Healthy Living Cohort found 28 percent of 671 patients had chronic diarrhea. This was more common in those with an AIDS-defining illness than HIV-positive patients in earlier stages of disease (Knox et al., 2000). The current incidence of chronic diarrhea is higher in the HIV-infected population than the general population, but can often be managed by changes in the anti-HIV regimen or by symptomatic treatment using diphenoxylate, loperamide, curcumin, or mesalamine.

Despite these advances, a small number of patients still have chronic and sometimes debilitating diarrhea from an opportunistic infection that cannot be effectively treated or diarrhea as an adverse reaction to antiretroviral agents that cannot be changed due to limited options (Esser et al., 2007; Monkemuller et al., 2000; Siddiqui et al., 2007; Tinmouth et al., 2007; Tramarin et al., 2004).

Although acute diarrhea continues to be a serious ailment affecting the lives of many infected with HIV, it usually resolves spontaneously or with treatment. Acute diarrhea does not meet the statutory definition of disability where a condition must last for 12 months or result in death. Chronic diarrhea is defined by the committee as a change in bowel habit with at least three loose or watery stools (i.e., take the form of the container) lasting for at least 3 weeks and unresponsive to standard treatment. Treatment protocols vary based on the cause of diarrhea and the stage of HIV infection. Many microbial pathogens can be treated with antibiotics, and some require combination antiretroviral therapy with immune recovery. Some patients benefit from “nonspecific therapy” such as loperamide.

Diarrhea is not specifically mentioned in other parts of the Listing of Impairments. Although cases of HIV patients with diarrhea that lasts for at least 12 months or result in death are rare, some do exist in late presenters or as a result of toxicity to HIV treatment. Therefore, the committee determined diarrhea should be included in the HIV Infection Listings when associated with marked limitation in functioning.

Distal Sensory Polyneuropathy

Peripheral neuropathy is a disease of the peripheral nervous system, associated with pain, weakness, and sensations such as burning and numb-

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