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Recently recognised microbial enteropathies and HIV infection
M J Farthing1, M P Kelly, A M Veitch
1Digestive Diseases Research Centre, Medical College of St Bartholomew's Hospital, London, UK.
The Journal of Antimicrobial Chemotherapy
|May 1, 1996
Summary
Persistent diarrhea in HIV/AIDS patients is often caused by specific pathogens like coccidia and microsporidia. Early detection via microscopy and biopsy, along with targeted treatments like albendazole and co-trimoxazole, are crucial for managing this condition.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Virology
Background:
- Persistent diarrhea and small bowel enteropathy are significant complications of Human Immunodeficiency Virus (HIV) infection.
- A specific enteropathogen can be identified in at least 80% of persistent diarrhea cases among HIV/AIDS patients.
- Coccidian parasites (Cryptosporidium parvum, Isospora belli, Cyclospora) and Microsporidia are major contributors, alongside Mycobacterium avium complex, bacteria, and cytomegalovirus.
Purpose of the Study:
- To review the causes and diagnostic approaches for persistent diarrhea in HIV infection.
- To highlight recent therapeutic advancements for specific enteropathogens causing diarrhea in HIV/AIDS.
- To address the uncertainty regarding HIV's direct role in causing enteropathy.
Main Methods:
- Review of existing literature on persistent diarrhea in HIV/AIDS.
- Discussion of diagnostic methods including fecal microscopy and intestinal mucosal biopsies.
- Analysis of treatment strategies for identified enteropathogens.
Main Results:
- Intracellular protozoa (coccidia, microsporidia) account for over 50% of persistent diarrhea cases.
- Diagnosis can be confirmed by fecal microscopy, though intestinal biopsies may be necessary.
- Up to 20% of cases remain without a specific identified infection, leaving the direct role of HIV in enteropathy unclear.
Conclusions:
- Specific enteropathogens are frequently responsible for persistent diarrhea in HIV/AIDS.
- Albendazole and co-trimoxazole are effective treatments for microsporidial and Cyclospora infections, respectively.
- Further research is needed to clarify the direct impact of HIV infection on enteropathy.