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Gastrointestinal Diseases in Children Living with HIV
Francesca Wanda Basile1, Maria Cristina Fedele2, Andrea Lo Vecchio3
1Baylor International Pediatric AIDS Initiative, Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, USA.
Insights
Pediatric HIV is now a chronic condition. This review guides managing gastrointestinal issues in children with HIV, focusing on early diagnosis and treatment adherence.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- HIV Medicine
Background:
- Pediatric HIV management has evolved into a chronic condition requiring multidisciplinary care.
- Gastrointestinal (GI) complaints are common in children, with intestinal involvement nearly universal in pediatric HIV.
- In high-prevalence areas, HIV is diagnosed in up to 25% of children hospitalized for diarrhea.
Purpose of the Study:
- To provide current guidance on managing gastrointestinal diseases in children with HIV.
- To address the spectrum of GI symptoms in HIV-infected children, from mild to severe.
- To inform the approach to GI issues in children initiating antiretroviral therapy (ART).
Main Methods:
- This is a review article.
- It synthesizes current knowledge on pediatric HIV and gastrointestinal manifestations.
- Guidance is based on established clinical practices and literature.
Main Results:
- Intestinal involvement is a hallmark of pediatric HIV infection.
- GI symptoms are prevalent in advanced HIV disease, including diarrhea, malabsorption, and failure to thrive.
- Children on ART can experience GI side effects, impacting adherence and quality of life.
Conclusions:
- Effective management of pediatric HIV requires addressing GI complications.
- Early and accurate diagnosis of GI issues is crucial for optimizing patient outcomes.
- Strategies to manage ART-related GI symptoms are necessary to ensure treatment adherence and improve quality of life.
Abstract:
Thanks to the advances in antiretroviral therapies (ART) and early diagnosis, pediatric HIV has turned into a chronic infection that requires the collaboration of all pediatric subspecialists for holistic patient management. Gastrointestinal complaints are a frequent reason for seeking access to medical care in all pediatric patients worldwide. Intestinal involvement is present in virtually all children with HIV infections. In high-prevalence settings, up to 25% of children accessing the hospital for diarrhea are diagnosed with HIV. More than half of patients with advanced disease present with gastrointestinal symptoms, from mild infectious diarrhea to severe gastrointestinal impairment, malabsorption and failure to thrive. Gastrointestinal disorders do not spare children on ART, particularly in the initial months of therapy. ART-associated pancreatitis and hepatitis are rare but potentially severe adverse events, whereas lower abdominal symptoms have been reported in more than a third of patients. The latter are usually mild and transient, but may limit ART adherence; a correct framing of the problem is necessary to minimize therapy switches while optimizing the quality of life of children on ART. This review aims to provide state-of-the-art guidance for the initial approach to gastrointestinal diseases in children living with HIV.
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