S3076 Unmasking the Hidden Burden: Regional Differences and Underreporting of Diarrhea in Virologically Suppressed HIV Patients

Introduction: HIV-associated diarrhea is a common but under-recognized condition that significantly impacts the quality of life in persons living with HIV (PLWH). Current estimates of the prevalence of this condition are inconsistent and outdated, as they mostly reflect the era of older antiretroviral therapy (ART) that was more frequently associated with gastrointestinal side effects. This issue is believed to be underreported, with evidence indicating that up to 15% of individuals affected do not disclose it to their healthcare provider. Understanding the true prevalence of HIV associated diarrhea, particularly in the context of modern ART, is essential to improve symptom recognition, management, and ART adherence. Methods: We conducted a multicenter cross-sectional survey study from December 2024 to April 2025, enrolling 110 people living with HIV from Saint Michael’s Medical Center (New Jersey) and the Mayo Clinic (Arizona). Inclusion criteria were adults on a stable dose of ART with virologic suppression (VL <50 copies/mL for ≥3 months and CD4 >100). Patients completed a structured paper questionnaire at the time of their routine clinic visits, reporting on demographic data, HIV regimen, use of anti-diarrheal medication, and diarrhea characteristics. Data were categorized by geographic region (Northeast NJ, Southwest AZ) and analyzed using descriptive statistics and chi-square testing to compare prevalence rates between subgroups. Results: Among the 110 participants, the majority were men (75%), aged 50–75 years (64%), and identified as Black (46%). The overall prevalence of diarrhea was 27% (n = 30), significantly higher in NJ compared to AZ (63% vs 36%, P = 0.007). Among those with diarrhea, the most commonly reported duration was 1 week, and 32% (n = 28) had not disclosed symptoms to a healthcare provider. No significant associations were observed between diarrhea and age group (P = 0.72), gender (P = 0.81), or ethnicity (P = 0.19). However, the sample size was relatively small, and subgroup analyses may have been underpowered to detect meaningful differences. Conclusion: Despite virologic suppression on modern ART, diarrhea remains prevalent in PLWH and may vary regionally. A substantial proportion of patients fail to report symptoms to their providers. These findings highlight the need for proactive symptom screening in HIV care, particularly in high-prevalence regions. Larger studies are needed to confirm these findings and better characterize demographic and regional differences.