Insights into gastrointestinal manifestation of human immunodeficiency virus: A narrative review

Abstract

Human immunodeficiency virus (HIV) modifies CD4-positive cells, resulting in immunodeficiency and a wide range of gastrointestinal (GI) manifestations. The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy (ART). While ART has effectively reduced the occurrence of opportunistic infections, it has led to an increase in therapy-related GI illnesses. Common esophageal conditions in HIV patients include gastroesophageal reflux disease, idiopathic esophageal ulcers, herpes simplex virus, cytomegalovirus (CMV), and candidal esophagitis. Kaposi’s sarcoma, a hallmark of acquired immunodeficiency syndrome, may affect the entire GI system. Gastritis and peptic ulcer disease are also frequently seen in patients with HIV. Diarrhea, often linked to both opportunistic infections and ART, requires careful evaluation. Bloody diarrhea, often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile, is prevalent. Small bowel lymphoma, although rare, is increasing in prevalence. Anorectal disorders, including proctitis, fissures, and anal squamous cell carcinoma, are particularly relevant in homosexual men, underlining the importance of timely diagnosis. This review comprehensively explores the epidemiology, pathogenesis, and treatment considerations for the various GI disorders associated with HIV, highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.

Keywords: Human immunodeficiency virus; Opportunistic infections; Antiretroviral treatment; Gastrointestinal

Core Tip: Human immunodeficiency virus (HIV) modifies CD4-positive cells, causing immunodeficiency and leading to various gastrointestinal (GI) issues. Highly active antiretroviral therapy (ART) has shifted the burden of HIV-related GI illnesses, reducing opportunistic infections while increasing GI problems associated with therapy, such as gastroesophageal reflux disease, non-infectious diarrhea, and HIV enteropathy. Diarrhea, linked to both infections and ART, requires careful evaluation to identify the etiology. Conditions such as colitis-related bloody diarrhea, small bowel lymphoma, and anorectal disorders, including proctitis and anal squamous cell carcinoma, also require timely diagnosis and management, especially in at-risk populations.