Idiopathic AIDS Enteropathy and Treatment of Gastrointestinal Opportunistic Pathogens

Abstract

Diarrhea in patients with acquired immune deficiency syndrome (AIDS) has proven to be both a diagnostic and treatment challenge since the discovery of the human immunodeficiency virus (HIV) virus more than 30 years ago. Among the main etiologies of diarrhea in this group of patients are infectious agents that span the array of viruses, bacteria, protozoa, parasites, and fungal organisms. In many instances, highly active antiretroviral therapy remains the cornerstone of therapy for both AIDS and AIDS-related diarrhea, but other targeted therapies have been developed as new pathogens are identified; however, some infections remain treatment challenges. Once identifiable infections as well as other causes of diarrhea are investigated and excluded, a unique entity known as AIDS enteropathy can be diagnosed. Known as an idiopathic, pathogen-negative diarrhea, this disease has been investigated extensively. Atypical viral pathogens, including HIV itself, as well as inflammatory and immunologic responses are potential leading causes of it. Although AIDS enteropathy can pose a diagnostic challenge so too does the treatment of it. Highly active antiretroviral therapy, nutritional supplementation, electrolyte replacements, targeted therapy for infection if indicated, and medications for symptom control all are key elements in the treatment regimen. Importantly, a multidisciplinary approach among the gastroenterologist, infectious disease physician, HIV specialists, oncology, and surgery is necessary for many patients.

Intestinal parasitic and candida infection associated with HIV infection in Cameroon

“…However, it should be noted that diarrhoea can occur as an adverse effect of antiretroviral treatment, especially with protease inhibitors [24]. CD4 + counts were still significantly associated with diarrhoea at the ≤ 350 cells/μL threshold, further justifying the World Health Organisation's recommendation to initiate antiretroviral treatment at CD4…”

HIV-induced immunosuppression is associated with colonization of the proximal gut by environmental bacteria

“…As such, the effect of HIV infection on the proximal gut microbiome is essentially unknown and most of the clinical complaints related to the proximal gut are simply interpreted as resulting from idiopathic HIV enteropathy. Given the lack of knowledge about the pathogens responsible for HIV enteropathy, treatment is limited to supportive measures, such as HAART, nutritional supplementation, and electrolyte replacements [41]. …”

Plasmacytoid dendritic cells are recruited to the colorectum and contribute to immune activation during pathogenic SIV infection in rhesus macaques

“…[1][2][3][4] The consequences of HIV/SIV infection not only include a deficit in mucosal CD4 T cells but also tissue damage and increased vulnerability to opportunistic infections. 5 HIV/SIVassociated pathology in the GI tract includes epithelial hyperplasiainduced villous atrophy, abnormal cellular infiltrates, disrupted lymphoid architecture, and increased apoptotic cells, mostly attributed to an overt and chronic inflammatory immune response during HIV/SIV infection. [6][7][8] By contrast, SIV-infected natural nonhuman primate hosts such as sooty mangabeys (SMs) and African green monkeys do not progress to simian AIDS, unlike nonnatural hosts such as infected rhesus macaques (RMs, Macaca mulatta).…”