II. Epidemiology
- Diarrhea is most common intestinal HIV manifestation
- Affects 50-90% of HIV patients
III. Signs
- Often voluminous Secretory Diarrhea
IV. Causes: Infectious (Pathogen identified in 85% of AIDS patient)
- Cryptosporidium
- Microsporidia
- Isospora belli
- Mycobacterium Avium Complex (MAC)
- Salmonella
- Campylobacter jejuni
- Cytomegalovirus (CMV) Infection
-
Herpes Simplex Virus (HSV)
- Can also cause rectal ulcers and pain
- Shigella
- Clostridium difficile
- Histoplasma capsulatum
V. Causes: Pathogen negative
- Gastrointestinal Cancer
- Fat malabsorption (related to pancreatic exocrine insufficiency)
- Sexually Transmitted Disease with secondary Proctitis or anorectal ulcers
- Protease Inhibitor related adverse effects
- HIV-induced Diarrhea (HIV-Induced Enteropathy or AIDS Enteropathy)
- Can be chronic and cause severe wasting
- More common when CD4 Count <200/mm3
- Considered a diagnosis of exclusion
- Unclear etiology
- Possibly due to focal mucosal immune defects
- Secondary to CD4 Cell Count depletion
- Leads to Bacterial overgrowth
- Leads to Mucosal inflammation
VI. Diagnosis
- Examine multiple stools first
-
Stool exam not diagnostic
- Upper and lower endoscopy with biopsies and cultures