Diarrhea can cause significant morbidity in HIV-infected patients, and can be due to a myriad of causes from infectious pathogens, malignancy and even medications. Before the use of HAART, chronic diarrhea was a large cause of AIDS-defining conditions. However, in the current era the infectious causes of diarrhea in HIV-infected individuals in declining. Key to the evaluation of diarrhea in HIV-infected individuals is a thorough history that includes duration of symptoms, frequency and characteristics of stool, amount of weight loss, and the presence of other abdominal symptoms and constitutional symptoms. Additionally, all medications should be reviewed. A careful physical examination is key to help determine the degree of wasting or to identify any particular findings that may point to specific diseases. For example, fever and wasting may suggest an underlying opportunistic infection. Initial investigations should include stool examination and cultures, and blood cultures. Abdominal CT imaging and endoscopy may be considered if the initial non-invasive work-up is non-diagnostic.
Below is a list of several key causes of diarrhea in HIV-infected individuals:
Bacterial: salmonella, campylobacter, MAC, TB, C. difficile, shigella
Viral: CMV, herpes simplex, adenovirus, norwalk
Protozoal: microsporidium, cryptosporidium
Fungal: histoplasmosis, coccidiomycosis
Gut neoplasms: lymphoma, Kaposi’s sarcoma
Pancreatic insufficiency
Infectious pancreatitis: CMV, MAC
Drug-induced pancreatitis: didanosine, pentamidine
Tumor invasion: lymphoma, Kaposi’s sarcoma
Idiopathic: “AIDS enteropathy”
1 comment :
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