Crofelemer for chronic noninfectious diarrhea in adults with HIV/AIDS receiving antiretroviral therapy: a review of plant-derived antisecretory pharmacotherapy.

Abstract

Introduction: Chronic noninfectious diarrhea remains a clinically important but often underrecognized complication in patients receiving long-term antiretroviral therapy (ART). Although modern human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) treatment has transformed survival, gastrointestinal adverse effects can impair adherence, quality of life, nutrition, social functioning, and treatment satisfaction. Crofelemer is an oral, plant-derived botanical drug developed as a non-systemic antisecretory therapy for noninfectious diarrhea in adults with HIV/AIDS receiving ART.

Areas covered: This review evaluates crofelemer as a plant-derived pharmacotherapy for chronic noninfectious diarrhea. It discusses the clinical need, limitations of current antidiarrheal approaches, botanical origin, chloride-channel mechanism, pharmacology, clinical efficacy evidence, safety and tolerability, practical prescribing considerations, real-world positioning, and investigational expansion into cancer therapy-related diarrhea and rare intestinal-failure disorders.

Expert opinion: Crofelemer offers a mechanistically distinct option for selected patients with chronic watery, noninfectious diarrhea whose symptoms remain burdensome despite appropriate clinical evaluation and supportive care. However, its use should be guided by realistic expectations, careful patient selection, and recognition that response is not universal. Future clinical value will depend on phenotype-based prescribing, real-world effectiveness data, comparative studies, affordability, and patient-reported outcomes.