HIV AND GASTROINTESTINAL MANIFESTATIONS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India
HIV enteropathy
Most common symptoms of
gastrointestinal involvement are chronic or recurrent
diarrhea, abdominal pain, dysphagia and failure to thrive. Secondary and
opportunistic infection are incriminated in most of the cases. However there exists an entity called as AIDS enteropathy or
HIV enteropathy which is characterized by chronic diarrhea and
malabsorption where no specific pathogen is associated. It is postulated that direct infection of the enterocytes by HIV leads to this syndrome. Histologically, small intestinal
biopsy reveals partial villous atrophy. Disaccharide intolerance is seen in these children which the cause of malabsorption and
diarrhea. Maintaining
nutrition is important in children with HIV enteropathy. This can be achieved by supplemental enteral feeding either by mouth or night time nasogastric feeds.
Hepatic involvement
Hepatomegaly is a common manifestation in pediatric group. Hepatitis is generally secondary to other co-infections like CMV,
hepatitis B or C,
tuberculosis, ARV drugs like
protease inhibitors and
nucleotide reverse transcriptase inhibitors (NRTI) and ATT. Hepatitis due to
HIV Virus per se is rare. Hepatotoxicity caused by the drugs is mostly reversible with reduction in dosage or removal of the offending drug. Co-infections require appropriate specific treatment. (See Chapter on HIV and Opportunistic Infections)
HIV and Pancreas
Pancreas is one of the many organs that may be affected by
HIV. Pancreatic inflammation can occur in asymptomatic patients and in patients with AIDS or in patients with lymphadenopathy syndrome. Asymptomatic elevation of serum amylase and lipase may be seen and monitoring of pancreatic serum enzymes is essential to diagnose pancreatitis. Hyperamylasemia may be seen with salivary involvement and hence elevated serum lipase is a better indicator for identifying those patients with pancreatitis.
Pancreatitis has also been associated with pentamidine isothionate exposure, CD4 cell count less than 100 cells/cumm, infective agents such as cytomegalovirus,
cryptosporidium, pneumocystis carinii
pneumonia and mycobacterium avium intracellulare. It has also been found in patients taking Didanosine (ddI) as part of their antiretroviral treatment.
References
- Shah Ira. Abnormal serum pancreatic enzymes in an HIV infected child. Indian J Med Res 2007; 126: 83-85.
- Koranyi KI, Brady M, Stock K, Lucas P, Nahata MC. Pancreatitis in children infected with human immunodeficiency virus. Pediatr AIDS HIV Infect. 1996;7:261-265.
Last Updated : 1
st September 2012.