Gastrointestinal Opportunistic Infections Research Articles

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020.

CLINICAL, AMNESTIC AND IMMUNOLOGICAL PARAMETERS IN HIV-INFECTED PATIENTS WITH GASTROENTEROLOGICAL DISEASES

Nowadays the relevance of questions of comorbidity of different pathologies, including HIV infection diseases of the digestive system. Structural and functional changes in HIV infection can occur in various organs of the digestive system: mouth, esophagus, stomach, liver and in the intestine. The aim of the study was to examine features of the social, epidemiologic, somatic and immune status in HIV infected patients with gastroenterological diseases. Materials and methods. The study involved 500 HIV infected patients consisting on the dispensary account in the Center for the prevention and control of AIDS of the Tyumen region. Results. Sex-age structure and epidemiological history among HIV infected patients with gastrointestinal pathology did not differ (p>0,05) of the total cohort of HIV infected Tyumen region — predominance of males, middle-aged with intravenous by HIV infection in the non-medical use of psychoactive substances. The most common gastrointestinal abnormalities in HIV infection are diseases of the gastroduodenal zone (68,2%) and diseases of the bile ducts (31,8 per cent). Indicators CD4, CD8, and LN of HIV infected to determine the diversity and severity of clinical symptoms resulting from lesions of the digestive tract. The prevalence of gastrointestinal disease in HIV infected patients had inverse correlation of medium strength with immunoregulatory index CD4/CD8 (r=-0,537; p<0,05). Conclusion. Pathogenetic defeat of the digestive system in HIV infection may be caused by direct impact of the virus on the gastrointestinal tract and opportunistic infections, and the indirect influence during chronic systemic inflammatory response and immunodeficiency condition, and also result from prolonged administration of drugs.

Investigation of Small Bowel Abnormalities in HIV-Infected Patients Using Capsule Endoscopy.

HIV infection is reportedly associated with an increased permeability of the intestinal epithelium and can cause HIV enteropathy, which occurs independently of opportunistic infections. However, the characteristics of small bowel abnormalities attributable to HIV infection are rarely investigated. In the present study, we assessed the intestinal mucosal changes found in HIV-infected patients and compared them with the mucosa of healthy control subjects using capsule endoscopy (CE). Three of the 27 HIV-infected patients harbored gastrointestinal opportunistic infections and were thus excluded from subsequent analyses. The endoscopic findings of CE in HIV-infected patients were significantly higher than those in control subjects (55% versus 10%, P = 0.002); however, most lesions, such as red spots or tiny erosions, were unlikely to cause abdominal symptoms. After validating the efficacy of CE for the diagnosis of villous atrophy, we found that the prevalence of villous atrophy was 54% (13/24) among HIV-infected patients. Interestingly, villous atrophy persisted in patients receiving long-term antiretroviral therapy, though most of them exhibited reconstituted peripheral blood CD4+ T cells. Although we could not draw any conclusions regarding the development of small bowel abnormalities in HIV-infected patients, our results may provide some insight regarding the pathogenesis of HIV enteropathy.

Candida associated diarrhea in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients and their correlation with CD4+ T lymphocyte counts

Context: Gastrointestinal opportunistic infections occur very frequently in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients and diarrhea is one of the common clinical presentations among these patients. Candida spp. have also been implicated as a causative agent of chronic diarrhea in HIV-infected patients. Aims: This study was carried out to determine the prevalence of fungal pathogen among HIV/AIDS patients presented with diarrhea and their correlation with CD4+ T lymphocyte counts. Settings and Design: This cross-sectional study was conducted in the Department of Microbiology, RIMS, Imphal. Materials and Methods: A total of 158 stool samples were examined, out of which 108 were from HIV-positive patients with diarrhea (study group) and 50 from HIV-positive patients without diarrhea (control group). Specimens were examined by direct microscopy and culture in Sabouraud's dextrose agar. The CD4+ T lymphocyte count of patient was also recorded. Statistical Analysis Used: Data were analyzed by using Statistical Package for the Social Sciences (SPSS) version-16 software. P predictive value) value <0.05 was considered significant. Results: Confluent growth of Candida spp. was detected in stool samples of 28.7% patients with diarrhea and 12% patients without diarrhea. Association between the isolation of Candida spp. and diarrhea was found to be significant (P = 0.01). Isolation of Candida spp. was inversely correlated with CD4+ T lymphocyte count. Conclusion: Intestinal candidiasis must be held in mind as a cause of HIV/AIDS-associated diarrhea, particularly in patient with low CD4+ T lymphocyte count.

W1431: Gastrointestinal Opportunistic Infections: Usefulness of Colonoscopy in HIV+ Patients With Chronic Diarrhea in the Era of HAART

W1431: Gastrointestinal Opportunistic Infections: Usefulness of Colonoscopy in HIV+ Patients With Chronic Diarrhea in the Era of HAART

Gastrointestinal opportunistic infections in human immunodeficiency virus disease.

Gastrointestinal (GI) opportunistic infections (OIs) are commonly encountered at various stages of human immunodeficiency virus (HIV) disease. In view of the suppressive nature of the virus and the direct contact with the environment, the GI tract is readily accessible and is a common site for clinical expression of HIV. The subject is presented based on information obtained by electronic searches of peer-reviewed articles in medical journals, Cochrane reviews and PubMed sources. The spectrum of GI OIs ranges from oral lesions of Candidiasis, various lesions of viral infections, hepatobiliary lesions, pancreatitis and anorectal lesions. The manifestations of the disease depend on the level of immunosuppression, as determined by the CD4 counts. The advent of highly active antiretroviral therapy has altered the pattern of presentation, resorting mainly to features of antimicrobial-associated colitis and side effects of antiretroviral drugs. The diagnosis of GI OIs in HIV/ acquired immunodeficiency syndrome patients is usually straightforward. However, subtle presentations require that the physicians should have a high index of suspicion when given the setting of HIV infection.

Gastroduodenal opportunistic infections and dyspepsia in HIV‐infected patients in the era of Highly Active Antiretroviral Therapy

Dyspeptic symptoms are frequently reported by human immunodefficiency virus (HIV)-infected patients under highly active antiretroviral therapy. Whether opportunistic infections are a cause of dyspepsia is still unknown. In this study we prospectively compare the prevalence of gastrointestinal opportunistic infections in dyspeptic versus non-dyspeptic HIV-infected patients with advanced immunodeficiency. Six hundred and ninety HIV-infected patients under highly active antiretroviral therapy underwent esophagogastroduodenoscopy with mucosal biopsies from the stomach and duodenum. Group 1: 500 patients (161 women, 339 men; mean age 38.8 years; mean CD4 count 154.3 cells/mm(3) with dyspeptic symptoms such as epigastric pain, nausea, vomiting and fullness. Group 2: 190 patients (169 men, 21 women; mean age 40.7 years; mean CD4 count 171.6 cell/mm(3)) with no dyspeptic symptoms. Group 1: Gastrointestinal opportunistic infections were observed in eight (1.6%), and non-opportunistic parasites in two (0.4%), patients. They were: Cytomegalovirus (four patients), Cryptosporidium sp. (two patients), Schistosoma mansoni sp. (one patient), Strongyloides stercoralis (one patient) and Giardia sp. (two patients). In five patients esophagogastroduodenoscopy showed no mucosal lesions. Group 2: Giardia sp. was detected in two patients (1.1%: P = 0.07947). Gastrointestinal opportunistic infections were shown in a small number of HIV-infected patients under highly active antiretroviral therapy with advanced immunodeficiency. Although gastrointestinal opportunistic infections were detected exclusively in the dyspeptic patient group, they could not be related to these symptoms, since the number of infected patients was not statistically significant. To correctly diagnose opportunistic infections, multiple biopsy specimens may be necessary even from normal-appearing mucosa.

Declining Gastrointestinal Opportunistic Infections in HIV-Infected Persons: A Triumph of Science and a Challenge for Our HAARTs and Minds

Gastrointestinal opportunistic infections, primarily oral and esophageal candidiasis, are common in persons infected with the human immunodeficiency virus (HIV) and contribute significantly to morbidity and mortality. Research early in the AIDS epidemic established a strong association between the presence of oral and esophageal candidiasis in patients complaining of odynophagia, demonstrated the diagnostic efficacy of a therapeutic trial with anti-fungal medicines, and defined the indications for endoscopy in HIV-infected persons with upper gastrointestinal complaints. Resulting diagnostic and treatment strategies with anti-fungal agents were very effective in preventing and treating mycotic infections of the gastrointestinal tract. Now, robust data from the United States and Europe indicate that recent advances in the development and use of highly active anti-retroviral therapy (HAART) are associated with a striking decline in the prevalence of oro-esophageal candidiasis in HIV-infected persons. In addition to developing more effective, safer antiviral agents, an HIV vaccine, and other novel approaches to combating this illness, a major challenge is to provide HAART to those without access to these life-saving drugs.

Light microscopic and electron microscopic diagnosis of gastrointestinal opportunistic infections in HIV-positive patients

The surgical pathologist is expected to recognise gastrointestinal opportunistic infections in biopsies from HIV-positive patients, and patients immunocompromised iatrogenically by cancer therapy, steroid treatment and transplantation immunosuppression regimes. This review article presents the diagnostic features in gastrointestinal biopsies of microsporidia, cyclospora, isospora, cryptosporidia, mycobacteria, adenovirus, enteropathogenic bacteria, cryptococcus and leishmania. All of these infections have been diagnosed at our hospital in Sydney, Australia, since the AIDS epidemic began. A protocol for the examination and assessment of these gastrointestinal biopsies is presented and discussed.

Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections.

During a 28-month period, endoscopic mucosal biopsy specimens from all HIV-infected patients were submitted for routine histologic evaluation. Immunoperoxidase staining for cytomegalovirus and herpesvirus antigens (esophagus), mycobacterial and fungal staining, and Gram staining of mucosal biopsy specimens were done. Special fungal and acid-fast stains were selectively performed in patients with absolute CD4 cell counts of less than 200 cells per microliter (200 x 10(6)/L) and/or with diarrhea and or wasting syndrome. Treatment was based on the endoscopic and histologic findings, and long-term follow-up was performed. The 121 symptomatic HIV-infected patients underwent 221 upper and/or lower endoscopies with 285 biopsy sites. The sensitivity and specificity of H&E staining for the diagnosis of gastrointestinal cytomegalovirus were 97% and 100%, respectively. The results of fungal and mycobacterial stains neither altered therapy nor identified previously undiagnosed infections in any patient. Long-term follow-up revealed no patient in whom an infection was missed on routine H&E, which affected outcome. Routine H&E staining is accurate for the diagnosis of gastrointestinal opportunistic infections in HIV-infected patients. Special histologic stains for fungal, mycobacterial, and viral infections did not increase the diagnostic yield or alter medical therapy but doubled the costs.

Morphine increases susceptibility to oral Salmonella typhimurium infection.

This study examined the effect of morphine on oral infection with virulent Salmonella typhimurium. Animals were treated with a 75-mg slow-release morphine pellet followed by inoculation with salmonellae. Morphine markedly sensitized mice to oral infection, as assessed by survival, mean survival time, and colony culture. By 24 h after Salmonella inoculation, morphine-treated mice had a 105-fold difference in number of organisms in the Peyer's patches, compared with controls. The opioid antagonist naltrexone significantly blocked Salmonella colonization in Peyer's patches and reduced Salmonella burden in other organs, indicating that morphine acts at least in part via an opioid receptor-mediated pathway. The data show that morphine markedly potentiates Salmonella infection at the gastrointestinal portal of entry and enhances subsequent dissemination of Salmonella organisms. The results have implications for potentiating gastrointestinal opportunistic infections in intravenous drug abusers and in opioid-medicated postsurgical patients.

Gastroenterological aspects of AIDS in the Third World

Gastrointestinal disease is the commonest presentation of AIDS in the Third World. Diarrhoea and weight loss are particularly common. Although many pathogens may be found, chronic cryptosporidiosis is the most frequent and there remains no specific effective therapy. Isospora belli is found in less than 10% of cases, but may be treated with cotrimoxazole, and long-term maintenance treatment to prevent relapse is effective. Oral disease, especially with candidiasis, is increasingly recognized and may be controlled with topical antifungal agents. The outlook for patients in the Third World who present with gastro-intestinal opportunistic infections associated with HIV infection is particularly dismal. Specific antiviral therapy, which has at least brought some hope and longer survival to patients in developed countries, remains largely unavailable in the Third World.

Radiologic spectrum of opportunistic infections of the upper gastrointestinal tract

Clinical findings and barium studies were reviewed in 34 patients with upper gastrointestinal opportunistic infections, including two with gastric involvement. The spectrum of radiologic features is presented with particular attention to early subtle findings such as disturbance of esophageal motility and tiny marginal filling defects. While most cases are due to Candida albicans, other organisms may also invade the upper gastrointestinal tract in the debilitated host.