Gastrointestinal manifestations of HIV infection

Abstract

Since the beginning of the AIDS pandemic, gastrointestinal (GI) problems have been among the most common features of the disease. Despite the introduction of highly active antiretroviral therapy (HAART) in 1995 and 1996, most HIV-infected patients continue to have GI complications. The clinician must be able to diagnose and treat the opportunistic gastrointestinal infections and neoplasms that occur in the advanced AIDS patient, as well as the treatment-induced symptoms and non-HIV-related GI disorders that predominate in early HIV disease. This review addresses the GI manifestations of HIV, with particular emphasis on new developments in the era of highly effective therapy.

Human Immunodeficiency Virus–Related Gastrointestinal Pathology: A Southern Africa Perspective With Review of the Literature (Part 2: Neoplasms and Noninfectious Disorders)

“…During the HAART era, the rising incidence of non-HIV-related disease in patients treated for HIV is responsible for an even wider drug exposure. 3 In my practice's experience, an increase in this range of pathology can be confirmed during the past few years, which mirrors the increasing availability of ART. Interestingly, the practice has seen a few cases of pill esophagitis in patients with HIV, which may have been precipitated by their emaciated or malnourished state (Figure 2, a and b).…”

“…These include various nucleoside and nonnucleoside reverse-transcriptase inhibitors, protease inhibitors, fusion/entry inhibitors, and integrase inhibitors, some of which are associated with more than a 10% incidence of diarrhea. 3 Histopathology is usually not available on these patients, however, because they seldom have biopsies. Additionally, patients with HIV may have sporadic exposure to various other drugs, including numerous antimicrobial and chemotherapeutic agents, for treatment of HIV-related complications.…”

“…The drugs documented to most often be associated with pill esophagitis in HIV are zidovudine (azidothymidine), zalcitabine, and doxycycline. 3 An increasingly important cause of drug-associated pathology after the introduction of HAART is Clostridium difficile-associated colitis. One large US study found it to be the most-common cause of HIV-associated bacterial diarrhea, the highest risk being in patients with AIDS.…”

“…IDIOPATHIC ESOPHAGEAL ULCERATION IN HIV Idiopathic esophageal ulcers, also known as chronic HIV-associated esophageal ulcerations, is a diagnosis of exclusion and usually occur in patients with CD4 cell counts less than 100/mL. 3 Idiopathic esophageal ulceration may also be seen during HIV seroconversion illness. A highly symptomatic lesion of uncertain etiology (postulated to be caused by HIV directly), it has been cited as being responsible for up to 40% of esophageal ulcers in patients with HIV.…”

“…2 The advent of highly active ART (HAART) or combination ART in developed countries has dramatically decreased the incidence of HIV-associated opportunistic infections and neoplasms, including those involving the gastrointestinal (GI) tract. [3][4][5][6] Although increasing availability of ART in sub-Saharan and southern Africa has significantly contributed to stabilizing the HIV pandemic, coverage is not complete, and many immunocompromised individuals with HIV infection still exist in the region. As a result, HIV-associated neoplasms, which frequently involve the GI tract, remain commonplace.…”