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 gastrointestinal 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.