II. Epidemiology

  1. Diarrhea is most common intestinal HIV manifestation
  2. Affects 50-90% of HIV patients

III. Signs

  1. Often voluminous Secretory Diarrhea

IV. Causes: Infectious (Pathogen identified in 85% of AIDS patient)

  1. CD4 Count <200/mm3
    1. Cryptosporidium
    2. Cyclospora
    3. Isospora belli (Cyclospora belli)
    4. Microsporidia
  2. CD4 <50/mm3
    1. Mycobacterium Avium Complex (MAC)
      1. May be associated with Hepatosplenomegaly and Lymphadenopathy
    2. Cytomegalovirus (CMV) Infection
      1. Fever accompanies Diarrhea
  3. Bacterial Inflammatory Diarrhea Causes (fever, bloody Diarrhea, esp. Men who have Sex with Men)
    1. Salmonella
    2. Campylobacter jejuni
    3. Shigella
  4. Other Bacterial causes of Diarrhea in HIV
    1. Clostridium difficile
    2. Small intestinal Bacterial overgrowth (SIBO)
      1. Presents with Diarrhea, weight loss, abdominal cramping, excessive Flatulence
      2. Lactulose breath test positive
    3. Mycobacterium tuberculosis
      1. Chronic Diarrhea alternating with Constipation
      2. May be associated with Hepatosplenomegaly and Lymphadenopathy
  5. Other viral causes of Diarrhea in HIV
    1. Herpes Simplex Virus (HSV)
      1. Associated with painful rectal ulcers and erosions
      2. May cause colitis
    2. Typical viral Diarrhea causes
      1. Adenovirus
      2. Rotavirus
      3. Norwalk Virus
  6. Other fungal causes of Diarrhea in HIV
    1. Histoplasma capsulatum
    2. Coccidiodomycosis
      1. Coccidioides immitis may cause peritonitis
  7. Other Parasitic Causes of Diarrhea in HIV
    1. Entamoeba histolytica (Amebiasis)
    2. Leishmania donovani (Leishmaniasis)
    3. Blastocystis hominis

V. Causes: Pathogen negative

  1. Gastrointestinal Cancer
    1. Non-Hodgkin Lymphoma
    2. Kaposi Sarcoma
    3. Anal Squamous Cell Carcinoma
  2. Fat malabsorption (related to pancreatic exocrine insufficiency)
    1. Infectious Pancreatitis (e.g. CMV, MAC)
    2. Drug-Induced Pancreatitis (e.g. Didanosine, Pentamidine)
  3. Sexually Transmitted Disease with secondary Proctitis or anorectal ulcers
  4. Protease Inhibitor related adverse effects
  5. HIV-induced Diarrhea (HIV-Induced Enteropathy or AIDS Enteropathy)
    1. Diarrhea can be chronic (>1 month) and cause malabsorption and severe wasting
    2. More common when CD4 Count <200/mm3
    3. Considered a diagnosis of exclusion
    4. Diagnostic Findings
      1. Small Bowel biopsy with low grade mucosal atrophy
      2. Small Bowel lactase decreased or absent
    5. Unclear etiology
      1. Possibly due to focal mucosal immune defects
      2. Secondary to CD4 Cell Count depletion
      3. Leads to Bacterial overgrowth and mucosal inflammation

VI. Diagnosis

  1. Examine multiple stools first
  2. Stool exam not diagnostic
    1. Upper and lower endoscopy with biopsies and cultures

VII. References

  1. Baloor (2018) Exam Preparatory Manual for Undergraduates Medicine, Jaypee Brothers, India, p. 236-7
  2. Dikman (2015) Dig Dis Sci 60(8):2236-45 +PMID: 25772777 [PubMed]
  3. Feasey (2011) Aliment Pharmacol Ther 34(6):587-603 +PMID: 21777262 [PubMed]

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Related Studies

Ontology: AIDS with infectious gastroenteritis (C0276575)

Concepts Disease or Syndrome (T047)
SnomedCT 77524007
English AIDS with infectious gastroenteritis (disorder), AIDS with infectious gastroenteritis
Spanish SIDA con gastroenteritis infecciosa, SIDA con gastroenteritis infecciosa (trastorno)

Ontology: HIV Enteropathy (C0282616)

Definition (MSHFRE) Diarrhée chronique et bien établie (persistant plus d'un mois) sans cause infectieuse identifiée après évaluation complète, chez un individu positif au VIH. On pense qu'elle proviendrait d'effets directs ou indirects du VIH sur la muqueuse intestinale. L'entéropathie VIH est un diagnostic d'exclusion qui peut être fait seulement après que d'autres formes de maladie diarrhéique aient été éliminées. (Harrison's Principles of Internal Medicine, 13th ed, pp1607-8; Haubrich et al., Bockus Gastroenterology, 5th ed, p1155)
Definition (MSH) A syndrome characterized by chronic, well-established DIARRHEA (greater than one month in duration) without an identified infectious cause after thorough evaluation, in an HIV-positive individual. It is thought to be due to direct or indirect effects of HIV on the enteric mucosa. HIV enteropathy is a diagnosis of exclusion and can be made only after other forms of diarrheal illness have been ruled out. (Harrison's Principles of Internal Medicine, 13th ed, pp1607-8; Haubrich et al., Bockus Gastroenterology, 5th ed, p1155)
Concepts Disease or Syndrome (T047)
MSH D019053
SnomedCT 235726002
English AIDS Associated Enteropathy, AIDS Enteropathies, AIDS Enteropathy, AIDS-Associated Enteropathies, AIDS-Associated Enteropathy, Enteropathies, AIDS, Enteropathies, AIDS-Associated, Enteropathies, HIV, Enteropathies, HIV-Associated, Enteropathy, AIDS, Enteropathy, AIDS Associated, Enteropathy, AIDS-Associated, Enteropathy, HIV, Enteropathy, HIV Associated, Enteropathy, HIV-Associated, HIV Associated Enteropathy, HIV Enteropathies, HIV Enteropathy, HIV-Associated Enteropathies, HIV-Associated Enteropathy, HIV-Hum imundefic vir enterop, Hum immundefic vir enteropath, Human immune defic virus diarr, Human immunodefic virus diarrh, HIV ASSOC ENTEROPATHY, ENTEROPATHY HIV ASSOC, ENTEROPATHY AIDS ASSOC, AIDS ASSOC ENTEROPATHY, infectious diarrhea of HIV patient, infectious diarrhea of HIV patient (diagnosis), HIV enteropathy, HIV Enteropathy [Disease/Finding], AIDS enteropathy, HIV enteropathy (diagnosis), AIDS Enteropathies, Idiopathic, AIDS Enteropathy, Idiopathic, Enteropathies, Idiopathic AIDS, Enteropathy, Idiopathic AIDS, Idiopathic AIDS Enteropathies, Idiopathic AIDS Enteropathy, HIV - Human immunodeficiency virus diarrhea, HIV - Human immunodeficiency virus diarrhoea, HIV - Human immunodeficiency virus enteropathy, Human immunodeficiency virus diarrhea, Human immunodeficiency virus diarrhoea, Human immunodeficiency virus enteropathy, Human immunodeficiency virus non-pathogenic diarrhea, Human immunodeficiency virus non-pathogenic diarrhoea, Human immunodeficiency virus enteropathy (disorder)
Swedish HIV-enteropati
Czech HIV enteropatie, AIDS enteropatie
Finnish HIV-enteropatia
Italian Enteropatia associata ad HIV, Enteropatia associata ad AIDS, Enteropatia da AIDS, Enteropatia idiopatica da AIDS, Enteropatia da HIV
Russian VICH ENTEROPATIIA, ENTEROPATIIA VICH, VICH ASSOTSIIROVANNAIA ENTEROPATIIA, SPID ENTEROPATIIA, SPID ASSOTSIIROVANNAIA ENTEROPATIIA, ВИЧ АССОЦИИРОВАННАЯ ЭНТЕРОПАТИЯ, ВИЧ ЭНТЕРОПАТИЯ, СПИД АССОЦИИРОВАННАЯ ЭНТЕРОПАТИЯ, СПИД ЭНТЕРОПАТИЯ, ЭНТЕРОПАТИЯ ВИЧ
Spanish Enteropatía por VIH, Enteropatía del VIH, enteropatía por HIV, enteropatía por VIH, enteropatía por virus de la inmunodeficiencia humana (trastorno), enteropatía por virus de la inmunodeficiencia humana, Enteropatía Asociada al SIDA, Enteropatía Asociada a VIH, Enteropatía del SIDA
Dutch hiv-enteropathie, Aids-enteropathie, Aids-geassocieerde enteropathie, Enteropathie, HIV-, HIV-enteropathie, HIV-geassocieerde enteropathie
French Entéropathie liée au VIH, Entéropathie du SIDA, Entéropathie liée au HIV, Entéropathie due au VIH, Entéropathie associée au SIDA
Japanese HIV腸症, HIVチョウショウ, AIDS関連腸炎, AIDS関連腸症, HIV腸炎, HIV腸症, エイズ腸症, エイズ関連腸炎, AIDS腸症, HIV関連腸炎, HIV関連腸症, エイズ関連腸症, 腸炎-HIV, 腸症-AIDS関連, 腸症-HIV
Polish Enteropatia związana z AIDS, Enteropatia w zakażeniu HIV, Enteropatia związana z zakażeniem HIV
Hungarian HIV enteropathia
Norwegian Hiv-enteropati
German AIDS-Enteropathie, AIDS-assoziierte Enteropathie, Enteropathie, HIV-, HIV-Enteropathie, HIV-assoziierte Enteropathie
Portuguese Enteropatia Associada a AIDS, Enteropatia Associada a HIV, Enteropatia em AIDS, Enteropatia por HIV

Ontology: infectious diarrhea of HIV patient due to opportunistic pathogens (C2049909)

Concepts Disease or Syndrome (T047)
English infectious diarrhea of HIV patient due to opportunistic pathogens (diagnosis), infectious diarrhea of HIV patient due to opportunistic pathogens