From the Guidelines
HIV-positive patients are at risk of developing various opportunistic infections affecting the gastrointestinal tract, including Candida esophagitis, cytomegalovirus (CMV) colitis, Cryptosporidium, Microsporidium, Mycobacterium avium complex (MAC), and herpes simplex virus (HSV) infections, as well as bacterial enteric infections such as Salmonella, Shigella, and Campylobacter 1. These infections can cause a range of symptoms, including diarrhea, abdominal pain, weight loss, and fever.
- Candidiasis typically presents as white plaques in the oropharynx or esophagus and is treated with fluconazole 100-200mg daily for 14-21 days.
- CMV causes ulcerative lesions throughout the GI tract and requires ganciclovir 5mg/kg IV twice daily for 2-3 weeks, followed by oral valganciclovir for maintenance.
- Cryptosporidiosis and microsporidiosis cause persistent diarrhea, with antiretroviral therapy being the primary treatment alongside nitazoxanide 500mg twice daily for cryptosporidiosis.
- MAC infection presents with abdominal pain, diarrhea, and malabsorption, requiring combination therapy with clarithromycin 500mg twice daily plus ethambutol 15mg/kg daily, with or without rifabutin.
- HSV infections cause painful oral or perianal ulcers and respond to acyclovir 400mg three times daily for 7-10 days.
- Bacterial enteric infections, such as Salmonella, Shigella, and Campylobacter, can cause self-limited gastroenteritis, severe and prolonged diarrheal disease, or septicemia, and require prompt diagnosis and treatment with antibiotics, as well as consideration of chronic suppressive therapy in some cases 1. The risk of developing these infections increases with the degree of immunosuppression, making immune reconstitution through effective antiretroviral therapy crucial for both prevention and management of these conditions 1.
From the Research
Common Opportunistic Infections in HIV Positive Patients
Some of the common opportunistic infections that affect the gastrointestinal tract (GIT) in HIV positive patients include:
- Esophageal candidiasis, which is the most common type of infectious esophagitis 2
- Helicobacter pylori infection, which has become the most common gastric infection 3
- Cytomegalovirus (CMV), cryptosporidia, and Mycobacterium avium complex (MAC) infections in the small bowel 3
- CMV, cryptosporidiosis, MAC, and spirochetosis in the large bowel 3
- Microsporidiosis, which is now being diagnosed with special stains 3
- Adenovirus, bacterial colitis, Kaposi sarcoma, and lymphoma 3
Factors Influencing Opportunistic Infections
The occurrence of opportunistic infections depends on the CD4 count and rises with CD4 decline 4. The advent of highly active antiretroviral therapy (HAART) has altered the pattern of presentation, resorting mainly to features of antimicrobial-associated colitis and side effects of antiretroviral drugs 5.
Diagnosis and Treatment
Diagnosis of GIT opportunistic infections in HIV/AIDS patients is usually straightforward, but subtle presentations require a high index of suspicion 5. Treatment options are available, including systemic antifungal drugs for esophageal candidiasis 2 and various therapeutic modalities for human intestinal cryptosporidiosis, such as nitazoxanide and human bovine colostrum 6.