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Diarrhea in HIV
Aka: Diarrhea in HIV, HIV related Diarrhea, AIDS Associated Diarrhea
- Epidemiology
- Diarrhea is most common intestinal HIV manifestation
- Affects 50-90% of HIV patients
- Signs
- Often voluminous Secretory Diarrhea
- Causes: Infectious (Pathogen identified in 85% of AIDS patient)
- Cryptosporidium
- Microsporidia
- Isospora belli
- Mycobacterium Avium Complex (MAC)
- Salmonella
- Campylobacter jejuni
- Cytomegalovirus (CMV) Infection
- Fever accompanies Diarrhea
- Herpes Simplex Virus (HSV)
- Can also cause rectal ulcers and pain
- Shigella
- Clostridium difficile
- Histoplasma capsulatum
- Causes: Pathogen negative
- Gastrointestinal Cancer
- Non-Hodgkin Lymphoma
- Kaposi Sarcoma
- Anal Squamous Cell Carcinoma
- 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
- Diagnosis
- Examine multiple stools first
- Stool exam not diagnostic
- Upper and lower endoscopy with biopsies and cultures