Abstract
Thanks to the advances in antiretroviral therapies (ART) and early diagnosis, pediatric HIV has turned into a chronic infection that requires the collaboration of all pediatric subspecialists for holistic patient management. Gastrointestinal complaints are a frequent reason for seeking access to medical care in all pediatric patients worldwide. Intestinal involvement is present in virtually all children with HIV infections. In high-prevalence settings, up to 25% of children accessing the hospital for diarrhea are diagnosed with HIV. More than half of patients with advanced disease present with gastrointestinal symptoms, from mild infectious diarrhea to severe gastrointestinal impairment, malabsorption and failure to thrive. Gastrointestinal disorders do not spare children on ART, particularly in the initial months of therapy. ART-associated pancreatitis and hepatitis are rare but potentially severe adverse events, whereas lower abdominal symptoms have been reported in more than a third of patients. The latter are usually mild and transient, but may limit ART adherence; a correct framing of the problem is necessary to minimize therapy switches while optimizing the quality of life of children on ART. This review aims to provide state-of-the-art guidance for the initial approach to gastrointestinal diseases in children living with HIV.
Highlights
Thanks to the advances in antiretroviral therapies (ART) and early diagnosis, pediatric Human immunodeficiency virus (HIV) has turned into a chronic infection that requires the collaboration of all pediatric subspecialists for holistic patient management
Infectious Diarrhea in ART-Naïve Children and Advanced Disease In ART-naïve children with diarrhea, investigating infectious causes is essential as even self-limiting infections caused by common GI pathogens tend to be more protracted and severe in HIV-infected individuals with poor immunological function compared with healthy children
In subjects with advanced HIV, some clinical and radiological findings found in severe intestinal infections or the presence of a thickening of the intestinal wall may require differential diagnosis with inflammatory bowel diseases (IBD)
Summary
The imbalances caused by HIV infection can alter the composition of the intestinal microbiota, favoring a permissive environment for the proliferation of pathogenic bacteria (pathobionts) [20]. Drugs can affect the gut microbial composition, but evidence on the direct effect of ART on the microbiome is limited, and results are affected by several confounding factors. In HIV-infected children, it is common to observe a reduction in Firmicutes (lactobacilli, streptococci, staphylococci, and clostridia) and an increase in Prevotella and Enterobacteriaceae, which have often been associated with microbial translocation, especially in children with low CD4 counts. These changes appear to be constant in cohorts of patients from different settings. More data from larger randomized controlled trials on children living with HIV are needed [30,31,32,33,34]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
