Gastrointestinal Diseases in Children Living with HIV

Abstract

Thanks to the advances in antiretroviral therapies (ART) and early diagnosis, pediatric HIV has turned into a chronic infection that requires the collaboration of all pediatric subspecialists for holistic patient management. Gastrointestinal complaints are a frequent reason for seeking access to medical care in all pediatric patients worldwide. Intestinal involvement is present in virtually all children with HIV infections. In high-prevalence settings, up to 25% of children accessing the hospital for diarrhea are diagnosed with HIV. More than half of patients with advanced disease present with gastrointestinal symptoms, from mild infectious diarrhea to severe gastrointestinal impairment, malabsorption and failure to thrive. Gastrointestinal disorders do not spare children on ART, particularly in the initial months of therapy. ART-associated pancreatitis and hepatitis are rare but potentially severe adverse events, whereas lower abdominal symptoms have been reported in more than a third of patients. The latter are usually mild and transient, but may limit ART adherence; a correct framing of the problem is necessary to minimize therapy switches while optimizing the quality of life of children on ART. This review aims to provide state-of-the-art guidance for the initial approach to gastrointestinal diseases in children living with HIV.

The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana

“…Importantly, co-infection with C. cayetanensis , a coccidian intestinal parasite, was associated with clinical symptoms, namely diarrhea over the previous 6 months and marked weight loss among those infected, which is in line with previous observations [ 7 ]. These findings are also broadly consistent with the body of literature demonstrating an association between immunosuppression and the risk of diarrhea-causing co-infection acquisition [ 28 , 29 , 30 ]. Intriguingly, however, the use of co-trimoxazole was not associated with significantly lower odds of co-infection; the adjusted odds ratio was 0.69 (95% CI: 0.35–1.29).…”

The Incidence and Risk Factors for Enterotoxigenic E. coli Diarrheal Disease in Children under Three Years Old in Lusaka, Zambia

“…The increased risk in HIV-positive children is consistent with previous studies. In a study conducted early in the HIV epidemic, the incidence of diarrhea was higher in HIV-infected infants when compared to HIV-uninfected infants [28,29]. Furthermore, HIVinfected infants are more likely to have recurrent, persistent, and more severe diarrhea than HIV-uninfected infants [30][31][32].…”

Molecular markers of acute intestinal infections in HIV-infected patients in the Chechen Republic

“…Полученные результаты подтверждают, что DEC являются наиболее распространёнными микроорганизмами, ассоциируемыми с диареей при ВИЧ-инфекции. Наиболее частой патогруппой были EPEC, которые широко распространены при ВИЧ с ДС [13,14]. Генетические маркеры возбудителей, передающихся, как правило, с пищевыми продуктами: Salmonella, Campylobacter и STЕС, были выявлены в 4,4, 10,9 и 25,5% случаев [15].…”