Diarrhea in aids patients

this presentation entails Etiology, Clinical presentation, Pathogenesis, Treatment and Prevention about Diarrhea in AIDS patients

1. College of Medicine and Health Sciences Infectious Diseases Diarrhea in AIDS patients

2. Scenario A 59-year-old woman with chronic HIV infection presents with a one-week history of diarrhea associated with mid-abdominal cramps, bloating, generalized pain and weakness. She describes six to eight loose bowel movements daily. Her most recent CD4 count is 0.22 × 10 9 /L, with an undetectable viral load. Her current antiretroviral (ARV) regimen consists of ritonavir-boosted atazanavir , tenofovir and emtricitabine .

3. Over half of patients with human immunodeficiency virus (HIV) experience diarrhea that can cause significant morbidity and can be due to a multitude of etiologies from infectious pathogens to malignancy to medications. D iarrhea remains a common complaint among these patients and continues to negatively impact the quality of life and adherence to antiretroviral therapy (ART) . Introduction

4. Etiology Worldwide, the most common causes of diarrhea in HIV-infected patients are enteric bacteria including  Shigella flexneri ,  Salmonella enteritidis and Campylbacter jejuni . Cytomegalo virus (CMV), cryptosporidiosis, microsporidia and Mycobacterium avium complex ( MAC) become important pathogens when immunodeficiency is advanced.

5. AIDS-related neoplasms such as Kaposi’s sarcoma or lymphoma and fungi rarely cause diarrhea . There is also non-infectious diarrhea in patients with HIV which is multifactorial and includes ART-associated diarrhea and gastrointestinal damage related to HIV infection (i.e., HIV enteropathy ) Cont’d

6. Gut-associated lymphoid tissue (GALT) is the largest collection of lymphoid tissue in the human body. The gastrointestinal (GI) tract is regularly exposed to a complex and diverse assortment of antigens from both microbial and dietary sources. As a result, naïve B and T cells of the gut are constantly interacting with antigens that induce their maturation into plasma cells and memory T cells, respectively. This persistent stimulation of the immune system leads to a baseline inflammatory state that encourages the production of chemokines and adhesion molecules, which mediate the movement of lymphocytes into the mucosal tissues, resulting into secretory Diarrhea. Pathophysiology

7. Regarding non-infectious diarrhea, HIV has been postulated to alter signaling and cellular structure, which may lead to architectural distortion. Several studies have demonstrated crypt epithelial proliferation in response to HIV infection, leading to increased crypt height, subsequent crypt cell encroachment onto villi, and relative decreased villous height resulting in diarrhea and malabsorption . Other hypotheses for the mechanism of HIV enteropathy include decreased transepithelial electrical resistance, decreased sodium-dependent glucose absorption, and increased intercellular permeability in HIV-infected cells. Cont’d

8. And regarding ART-Associated Diarrhea , D iarrhea is an adverse effect of ART, protease inhibitors seem to be most strongly associated with diarrhea Cont’d

9. This figure illustrates the c ommon causes of diarrhea at different stages of HIV infection and treatment . The  shaded boxes  indicate causes of diarrhea at different stages of HIV infection based on CD4+ T cell count. The impact of starting ART on CD4+ T cell counts is depicted by the  gray dotted line . 

10. Rehydration via intravenous and oral routes, repletion of electrolytes. E mpiric antibiotic therapy with a quinolone and  metronidazole Noninfectious diarrhea can be managed by modifying ART and controlling symptoms with medications and lifestyle modification . ColoPlus ®   IMCARE has been proven   to alleviate diarrhea and sustain weight gain in HIV-infected individuals. Management

11. The current WHO guidelines recommend co- trimoxazole prophylaxis for persistent diarrhoea in HIV-positive patients.  And Application of key measures to  prevent diarrhoea  which include use of improved sanitation, hand washing with soap, good personal and food hygiene,… Prevention

12. https://www.aidsmap.com/news/dec-2004/who-guidelines-treatment-diarrhoea-hiv-patients-may-need-revising-some-settings-says#:~:text=Current%20WHO%20guidelines%20recommend%20co,erythromycin%20were%20all%20widely%20effective . https://www.slideshare.net/ShimaGh/diarrhea-61105934/2 https://www.uptodate.com/contents/evaluation-of-the-patient-with-hiv-and-diarrhea?source=bookmarks_widget#H12120099 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499110/#:~:text=Over%20half%20of%20patients%20with,fungi%2C%20viruses%2C%20and%20bacteria . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723481/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218691/ References