GI

Gastrointestinal Manifestations of HIV

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Gastrointestinal Manifestations of HIV, HIV-related Gastrointestinal Conditions

  • See Also
  1. HIV Complications
  2. Dysphagia in HIV
  3. Vomiting in HIV
  4. Gastritis in HIV
  5. Gastric Outlet Obstruction in HIV
  6. Diarrhea in HIV
  7. Pancreatitis in HIV
  • Pathophysiology
  1. Gastrointestinal symptoms are common in HIV (increased with lower CD4 Counts)
  2. CD4+ Cells (T Cells) are reduced in the Gastrointestinal Tract in HIV Infection
    1. Allows for microbial translocation from the gut to systemic circulation
    2. Allows for chronic inflammation, affecting multiple systems (e.g. cardiovascular, liver, cognitive)
  • Differential Diagnosis
  1. Infectious Esophagitis, Gastroenteritis and colitis
    1. Dysphagia in HIV (or Odynophagia in HIV)
    2. Nausea in HIV (or Vomiting in HIV)
    3. Gastritis in HIV
    4. Gastric Outlet Obstruction in HIV
    5. Diarrhea in HIV
  2. Infiltrative hepatobiliary infections
    1. AIDS Cholangiopathy
    2. Hepatitis in HIV
    3. Peliosis Hepatitis
  3. Infiltrative pancreatic infections
    1. Pancreatitis in HIV
  4. Rectal lesions
    1. Genital Warts (especially anorectal warts)
    2. Anorectal lesions (consider Colorectal Cancer)
  5. Gastrointestinal Malignancy in HIV
    1. Kaposi Sarcoma (esp. affecting duodenum)
    2. Non-Hodgkin Lymphoma (esp. terminal ileum)
    3. Anal Cancer (squamous cell, associated with HPV Infection)
  1. Nausea, Dyspepsia and Diarrhea
    1. Common adverse effects (esp. Protease Inhibitors)
    2. Inquire about side effects at each visit to prevent non-compliance
  2. Hepatotoxicity
    1. Protease Inhibitors (esp. older agents)
    2. Nevirapine (NNRTI)
  3. Withdrawal of NRTI (Emtricitabine, Lamivudine, Tenofovir)
    1. Agents have activity against Hepatitis B Infection (in addition to HIV Infection)
    2. Hepatitis BVirus Infection may flare when these medications are stopped
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]