By R. Morgan Griffin InteliHealth Correspondent Gastrointestinal problems are common for people with HIV. In one recent study conducted by the New England Medical Center, 88 percent of HIV-positive people were found to have abnormalities in gastrointestinal function.
Having AIDS puts you at risk of developing opportunistic infections, and it increases your risk of some cancers. For example, two potential intestinal infections that can affect people with HIV — cryptosporidiosis and cytomegalovirus — may cause mild and temporary illness in people with healthy immune systems, yet they can be chronic and serious ailments in people with compromised immune systems. Another example is lymphoma, a cancer that can appear in the intestine or the lymph nodes in the abdomen. Lymphoma is a particularly common cancer in HIV-positive people. In addition, many HIV medications can cause diarrhea as a side effect.
Identifying The Symptoms
Common signs of HIV-related gastrointestinal problems include:
- Diarrhea
- Vomiting
- Difficulty swallowing
- Pain when swallowing
- Abdominal cramps
- Flatulence
- Weight loss
Some gastrointestinal problems associated with HIV can cause poor absorption of nutrients. Combined with chronic diarrhea and weight loss, this can lead to HIV wasting syndrome, a life-threatening loss of body weight.
Classifying The Causes
It would be impossible to list all of the possible illnesses that can affect the gastrointestinal tract in a person with HIV. Here are some of the more significant problems that may explain gastrointestinal symptoms in a person with HIV.
Cryptosporidiosis — Cryptosporidiosis is a parasitic infection of the intestines that causes diarrhea, cramps and flatulence. This infection is spread through the feces of infected animals and people. To avoid this infection, if you have HIV you should make sure to wash hands after touching soil or animals and should avoid eating unwashed vegetables and fruit, engaging in oral-anal sexual contact, or swallowing water from lakes, pools or anywhere in which contamination is possible. (The parasite Cryptosporidium can survive even in chlorinated water.) Although anyone with HIV can get cryptosporidiosis, it is dangerous to people whose immune systems are significantly impaired (CD4 counts of less than 150 cells per microliter). Although cryptosporidiosis can sometimes be treated with antibiotics, the best treatment is antiretroviral drugs for HIV, so that your immune system can be restored to fight this infection.
Bacterial infections — The bacterial pathogens that can cause gastrointestinal problems in HIV are numerous. Although these bacterial infections can make anyone sick, they are of greater danger to you if you have a compromised immune system. If you have HIV, it is important for you to be cautious to avoid ingesting contaminated food. You should avoid eating raw or undercooked eggs or undercooked poultry, meat or seafood, and you shouldn't consume unpasteurized dairy products. Avoid contact with any animal that has diarrhea, and always wash your hands after handling pets. Your risk of developing severe symptoms from traveler's diarrhea is increased if you are HIV-positive and get this infection. Therefore, be especially careful to avoid exposure to potentially contaminated food and water. If you plan to travel, discuss the possibility of taking preventive antibiotics to decrease your risk of developing traveler's diarrhea.
Microsporidiosis — Microsporidia are spore-forming fungi (previously classified by error as parasites) that cause chronic watery diarrhea and abdominal pain among HIV-positive patients. Medications such as albendazole are often effective in treating microsporidiosis, but HIV treatment with highly active antiretroviral therapy (HAART) is an even more important treatment, because it allows your immune system to recover so it can help to fight this infection.
Cytomegalovirus — Cytomegalovirus (CMV) is an very common virus that is usually harmless in people with normal immune systems but dangerous in people with HIV. CMV most often affects the eyes, throat and colon, although it can affect other organs as well. When it affects the gastrointestinal system, it may cause diarrhea, cramps, weight loss, fever and abdominal pain. For people with HIV, it is usually of concern only to people with CD4 counts of less than 50 cells per microliter. Treatment with ganciclovir, foscarnet, cidofovir or valgancyclovir (a new oral antibiotic) can kill cytomegalovirus, but many people relapse after treatment. Treatment usually includes six weeks of intravenous antibiotic, and relapse may require long-term antibiotic use to suppress the infection. Preventive medication can be stopped for a person who takes highly active antiretroviral therapy (HAART) and who has blood tests that show a rise in CD4 count to more than 100 or 150 cells per microliter for at least three months, without symptoms or evidence of active CMV disease.
Mycobacterium avium complex (MAC) — Mycobacterium avium is a type of bacteria similar to the bacteria that cause tuberculosis. It is harmless to people who have a normally functioning immune system. In a person with AIDS, Mycobacterium avium spreads throughout the body. Doctors call this widespread infection "disseminated" infection. MAC can affect many organs. Gastrointestinal symptoms include abdominal pain, weight loss and diarrhea. This infection usually affects people who have quite low CD4 counts, less than 50 or 100 cells per microliter. If you have a low CD4 count, your doctor may recommend clarithromycin or azithromycin to prevent infection. This preventive medicine can be stopped if your CD4 count improves to higher levels.
Cancer — Non-Hodgkin's lymphoma can cause abdominal pain, gastrointestinal bleeding and fever. Although it can occur in anyone, it is more likely in people with CD4 counts of less than 100 cells per microliter. Kaposi's sarcoma, another type of cancer that can affect HIV-positive people, can also grow in the digestive tract, although it does not always cause symptoms. HIV-positive people, especially men who have sex with men, are at risk of anal cancer. The development of anal cancer is caused by infection with human papillomavirus, a sexually transmitted disease.
Other HIV-related infections can also affect the gastrointestinal tract, such as herpes virus and the fungal infection thrush (candidiasis), which can cause pain in the mouth and difficulty swallowing. In addition, hepatitis B and hepatitis C can cause grave damage to the liver.
Establishing A Diagnosis
If you have gastrointestinal symptoms, your evaluation will need to be comprehensive, including a thorough physical examination, blood tests, stool tests and potentially one or more procedures, such as sigmoidoscopy or colonoscopy. Sometimes, several opportunistic infections are present at once. Side effects to medications may also produce gastrointestinal symptoms, so the time that your symptoms began should be compared with changes that were made in your medications.
Practicing Prevention
If you have a low CD4 count or a high viral load, it will almost certainly benefit you to take antiretroviral medication to treat your HIV infection. If you have a low CD4 count, you can additionally benefit from carefully chosen antibiotics to prevent the development of an opportunistic infection. This preventive ("prophylactic") medicine should be continued until your immune system rises above dangerous levels. If you have had one or more opportunistic infections, you may be advised to take an antibiotic to suppress those particular infections for the rest of your life, regardless of your CD4 count or viral load.
If you plan to travel, ask your doctor if you should take special precautions. Your doctor may recommend additional prophylactic antibiotic medicine. If you travel to a developing country, take precautions: Wash your hands regularly and avoid consuming raw fruits or vegetables, raw or undercooked meat, seafood and untreated water or ice.
Treating Gastrointestinal Ailments
Treatment of gastrointestinal opportunistic infections usually consists of oral antibiotic medications, often taken several times a day. Certain infections require treatment by intravenous antibiotics. Chemotherapy or radiation are standard treatments for Kaposi's sarcoma and non-Hodgkin's lymphoma.
Medications for preventing or treating opportunistic infections can cause gastrointestinal problems themselves — especially diarrhea — along with other side effects. Make sure to report any side effects to your doctor; he or she may be able to adjust your dosage or substitute a drug that you can better tolerate.
