HIV in Children

HIV AND GASTROINTESTINAL MANIFESTATIONS

Dr. Ira Shah
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Last Updated : 1st September 2012

HIV enteropathy


Most common symptoms of gastrointestinal involvement are chronic or recurrent diarrhea, abdominal pain, dysphagia and failure to thrive. Secondary and opportunistic infection are incriminated in most of the cases. However there exists an entity called as AIDS enteropathy or HIV enteropathy which is characterized by chronic diarrhea and malabsorption where no specific pathogen is associated. It is postulated that direct infection of the enterocytes by HIV leads to this syndrome. Histologically, small intestinal biopsy reveals partial villous atrophy. Disaccharide intolerance is seen in these children which the cause of malabsorption and diarrhea. Maintaining nutrition is important in children with HIV enteropathy. This can be achieved by supplemental enteral feeding either by mouth or night time nasogastric feeds.

Hepatic involvement


Hepatomegaly is a common manifestation in pediatric group. Hepatitis is generally secondary to other co-infections like CMV, hepatitis B or C, tuberculosis, ARV drugs like protease inhibitors and nucleotide reverse transcriptase inhibitors (NRTI) and ATT. Hepatitis due to HIV Virus per se is rare. Hepatotoxicity caused by the drugs is mostly reversible with reduction in dosage or removal of the offending drug. Co-infections require appropriate specific treatment. (See Chapter on HIV and Opportunistic Infections)

HIV and Pancreas


Pancreas is one of the many organs that may be affected by HIV. Pancreatic inflammation can occur in asymptomatic patients and in patients with AIDS or in patients with lymphadenopathy syndrome. Asymptomatic elevation of serum amylase and lipase may be seen and monitoring of pancreatic serum enzymes is essential to diagnose pancreatitis. Hyperamylasemia may be seen with salivary involvement and hence elevated serum lipase is a better indicator for identifying those patients with pancreatitis.

Pancreatitis has also been associated with pentamidine isothionate exposure, CD4 cell count less than 100 cells/cumm, infective agents such as cytomegalovirus, cryptosporidium, pneumocystis carinii pneumonia and mycobacterium avium intracellulare. It has also been found in patients taking Didanosine (ddI) as part of their antiretroviral treatment.

References


  1. Shah Ira. Abnormal serum pancreatic enzymes in an HIV infected child. Indian J Med Res 2007; 126: 83-85.
  2. Koranyi KI, Brady M, Stock K, Lucas P, Nahata MC. Pancreatitis in children infected with human immunodeficiency virus. Pediatr AIDS HIV Infect. 1996;7:261-265.


HIV AND GASTROINTESTINAL MANIFESTATIONS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.