What are the symptoms of HIV enteropathy?

Symptoms of HIV Enteropathy

HIV enteropathy is characterized by chronic diarrhea, weight loss, malabsorption, and gastrointestinal dysfunction in HIV-infected individuals, even in the absence of identifiable opportunistic pathogens. 1, 2

Primary Symptoms

• Chronic diarrhea - persistent, often watery stools that may be severe and prolonged 1
• Weight loss - significant (≥10%) involuntary weight loss, which may occur even without other symptoms 1
• Malabsorption - impaired absorption of nutrients, particularly fats and disaccharides 2
• Abdominal pain - can be present with or without concurrent gastrointestinal illness 1

Gastrointestinal Manifestations

• Altered stool consistency - typically loose or watery 3
• Increased bowel movement frequency - multiple daily bowel movements 3
• Bloating - abdominal distension and discomfort 1
• Nausea - may be present and can affect nutritional intake 1

Systemic Manifestations

• Fever - may accompany diarrheal disease, particularly when severe 1
• Fatigue - often related to malnutrition and systemic inflammation 1
• Muscular fatigue - functional impairment due to undernutrition 1
• Work incapacity - decreased ability to perform daily activities 1

Laboratory and Diagnostic Findings

• Decreased D-xylose absorption - indicating malabsorption 3
• Altered intestinal permeability - increased lactulose recovery and decreased mannitol recovery 4
• Villous atrophy - architectural changes in the small intestine 5
• Crypt elongation - morphological changes in intestinal crypts 5
• Decreased CD4 lymphocyte density in intestinal mucosa 3
• Elevated intestinal-fatty acid binding protein (I-FABP) - marker of enterocyte damage 3

Distinguishing Features

HIV enteropathy should be distinguished from:

1. Opportunistic infections - which must be excluded before diagnosing HIV enteropathy 1, 5
2. Medication-induced enteropathy - from antiretrovirals or other medications 1
3. HIV wasting syndrome - which includes weight loss with fever and/or diarrhea of unknown origin 1
4. Lipodystrophy - a complication of antiretroviral treatment with fat redistribution 1

Severity Factors

The severity of HIV enteropathy symptoms increases with:

• Degree of immunosuppression - more profound illness occurs with advancing HIV disease 1
• Duration of HIV infection - symptoms typically worsen as disease progresses 4
• Absence of effective antiretroviral therapy - HAART has decreased the incidence of wasting 1

Pathophysiological Mechanisms

HIV enteropathy appears to involve:

• Direct viral effects - HIV gp120 protein can cause increased intestinal permeability and decreased glucose transport 6
• Mucosal immune dysfunction - reduced intestinal immunity 2
• Autonomic neuropathy within the jejunum 2
• Cytokine-mediated effects - TNF-alpha/cachectin may contribute to weight loss 2

Early recognition of these symptoms is crucial as HIV enteropathy contributes significantly to morbidity and mortality in HIV-infected individuals, with decreased nutritional status independently associated with increased mortality 1.