II. Pathophysiology
- Gastrointestinal symptoms are common in HIV (increased with lower CD4 Counts)
- CD4+ Cells (T Cells) are reduced in the Gastrointestinal Tract in HIV Infection
- Allows for microbial translocation from the gut to systemic circulation
- Allows for chronic inflammation, affecting multiple systems (e.g. cardiovascular, liver, cognitive)
III. Differential Diagnosis
- Infectious Esophagitis, Gastroenteritis and colitis
- Infiltrative hepatobiliary infections
- Infiltrative pancreatic infections
- Rectal lesions
- Genital Warts (especially anorectal warts)
- Anorectal lesions (consider Colorectal Cancer)
- Gastrointestinal Malignancy in HIV
- Kaposi Sarcoma (esp. affecting duodenum)
- Non-Hodgkin Lymphoma (esp. terminal ileum)
- Anal Cancer (squamous cell, associated with HPV Infection)
IV. Associated Conditions: Antiretroviral Therapy Adverse Effects
-
Nausea, Dyspepsia and Diarrhea
- Common adverse effects (esp. Protease Inhibitors)
- Inquire about side effects at each visit to prevent non-compliance
- Hepatotoxicity
- Protease Inhibitors (esp. older agents)
- Nevirapine (NNRTI)
- Withdrawal of NRTI (Emtricitabine, Lamivudine, Tenofovir)
- Agents have activity against Hepatitis B Infection (in addition to HIV Infection)
- Hepatitis BVirus Infection may flare when these medications are stopped