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Gastrointestinal disease in AIDS is common and is due to opportunistic infections, aggressive malignancy and possible direct HIV enteropathy. Disabling gastrointestinal symptoms are prominent both in patients with established AIDS and in patients with earlier stages of HIV infection. We report the cases of 160 patients with AIDS who underwent gastroenterological investigations at St Vincent's Hospital, Sydney, between November 1983 to October 1987. Of these, 127 had the diagnosis of AIDS established prior to referral and 33 patients had the diagnosis of AIDS established as a result of gastroenterological investigations. Diarrhoea and weight loss (88%) were the most frequent reasons for undertaking gastroenterological investigations. Swallowing disorders (47%), abdominal pain (20%), oral and perianal disease (74%) and evidence of hepatobiliary disease were the other major indications for investigation. In 90% of cases there was evidence of concurrent and active gastrointestinal disease at two or more sites within the alimentary tract. Results from this series reveal a wide range of infectious pathogens: viral (Cytomegalovirus, Herpes simplex), bacterial (Mycobacterium avium intracellulare) and parasitic (Cryptosporidium, Isospora belli). Kaposi's sarcoma and non-Hodgkin's lymphoma were the only malignancies detected in this series. Gastrointestinal disease associated with HIV infection is common, and contributes significantly to its overall morbidity and mortality. Moreover, chronic diarrhoea, weight loss and malnutrition may also contribute to the overall immunodeficiency.
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PMID:The gastrointestinal manifestations of AIDS. 234 18

The beginning of sex life is occurring at an ever younger age in industrial countries with the result of frequently unexpected and unwanted pregnancies. In primitive societies puberty starts later because protein-rich nutrition is lacking. The recommendation of contraceptive methods for young people in Western countries serves the same purpose of lengthening the period until sexual maturity. The extent to which contraceptive methods influence the menstrual cycle of young women depends on the level of maturity of their cycle: IUDs and hormonal contraceptives affect it, but natural methods do not. Barrier methods do not influence it either, but the condom promoted against AIDS is not reliable enough as a contraceptive. The intrauterine pessary is rarely used owing to the increased risk of genital inflammation. Effects on the cycle produce symptoms of stronger and longer bleeding and amenorrhea possibly linked to coagulation. In animal experiments corpus luteum insufficiency was demonstrated. Hormonal contraception is also the safest for young people. The degree of the suppression of the gonadal axis depends on the dose of the components and the chemical structure of the gestagens used as well as on the endocrine maturity level and ovarian susceptibility of the user. The so-called postpill amenorrhea does not occur more often than secondary amenorrhea in the general population. When using micropills sufficient suppression of the gonadal axis has to be watched, otherwise clinical symptoms of delayed ripening of the ovaries develops with additional endogenic estrogen secretion: lower abdominal pain, breast complaints, and bleeding disorders. The longterm effect of increased estrogen concentrations is characterized by oligomenorrhea and corpus luteum insufficiency in the menstrual cycles of young women.
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PMID:[Contraception for adolescents and its effect on menstruation]. 238 9

Twenty-two patients with Whipple's disease are reviewed (21 male, 1 female; mean age 49.3 years). All but one were diagnosed by small intestinal biopsy. The most frequent clinical symptoms at diagnosis were weight loss (14/21 patients), diarrhea (13/21), arthralgias (13/21), cramping abdominal pain (11/21), and skin pigmentation (8/21), which anteceded the diagnosis by from 6 months to 10 years (median 3.5 years). All but three patients were treated successfully with tetracycline given for at least 2 years. Follow-up was done for a median of 7.7 years (range 1-15 years). Two of 17 patients who were followed for 2 years relapsed, as did 2/11 followed for at least 5 years. One patient relapsed twice. Each relapse could be treated with success. In no case did relapse occur in the central nervous system. Thus, tetracycline appears to be effective in the treatment of Whipple's disease if given for at least 2 years. In two further patients with confirmed central nervous system involvement at diagnosis, who were treated with ampicillin plus chloramphenicol, characteristic SPC cells disappeared from the cerebrospinal fluid. In addition, the recently recognized problems in the differential diagnosis of Whipple's disease and atypical mycobacterial infection in AIDS patients are discussed.
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PMID:Whipple's disease: a report of 22 patients. 245 1

Inpatient and community-based care can be complementary in relation to the management of HIV disease. Medical records from 200 inpatients of Chikankata Hospital near Lusaka, Zambia and 200 home based patients were examined and compared for the common symptoms of presentation of HIV disease, associated opportunistic infections, and treatment protocols. Drug costs of both groups were also compared. The most common respiratory symptoms in the 2 groups are cough, chest pains, weight loss, and hemoptysis. Treatment employed for these symptoms were cortimoxazole, penicillin V, erthromycin, and tetracycline. Acetyl saliclic acid and paracetamol were used for pain relief in both groups. Gastointestinal system symptoms for both groups were diarrhea, weight loss, abdominal pain, and vomiting. Cotrimoxazole and metronidazole were used in treating diarrhea. Additional treatment protocol for the 2 patient samples included oral rehydration therapy for dehydration, antacid or bismuth subsalicylate for diarrhea and enteritis, and mycostatin for oral candidiasis. Central nervous system symptomatology included headache, dementia, neckace, and lethargy. Chloramphenicol was employed in treating bacterial meningitis. Diazepam and chlorpromazine were effective for restless patients. Genito-urinary system symptomatology for the 2 groups included dysuria, genital ulcers, hematuria, viral warts, and buboes. Antibodies were used for sexually transmitted diseases and infections. Skin symptomatology included rash and dermatitis, herpes zoster, abscess, kaposi's sarcoma, ulcers, furunculosis, and discharging anal sinus. In treating these symptoms, hospital based care and home based care were similar. Overall, it was found that hospital treatment protocols were detailed, expensive, and time consuming. Furthermore, hospital treatment for HIV positive patients is more expensive than HIV negative patients; hospital costs for 50 HIV negative patients totaled US$415.94 compared to US$1204.98 HIV positive/PTB negative patients and US$1705.62 for HIV positive/PTB positive patients. Drug cost/patient admission is increased by 469% if HIV positive. (author's modified).
AIDS Care 1989
PMID:Clinical care as part of integrated AIDS management in a Zambian rural community. 248 94

Fusidic acid has previously been noted to prevent syncytial formation by human immunodeficiency virus (HIV) in vitro. Since this drug is a cheap, usually well-tolerated substance with known toxicity profile, an open, uncontrolled trial was undertaken to evaluate its possible efficacy in HIV disease. Twenty HIV antibody positive patients (10 with AIDS and 10 with ARC) were treated with sodium fusidate 500 mg every 8 h for up to 3 months. One patient died during therapy and six ceased treatment due to adverse events. Rash, nausea, diarrhea, and/or abdominal pain caused difficulties in all patients. There was no significant improvement in clinical state or T-helper cell levels, and no observed decrease in HIV p24 antigen during treatment. We conclude that in this open trial, sodium fusidate had no observable beneficial clinical, virological, or immunological effects.
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PMID:Clinical, immunological, and virological effects of sodium fusidate in patients with AIDS or AIDS-related complex (ARC): an open study. 249 93

Disseminated cytomegalovirus infection in patients with AIDS usually involves the lungs, retina, esophagus, or colon. Gastrointestinal involvement may present clinically with fever, intractable diarrhea, and crampy abdominal pain. Ulcerations have been seen throughout the gastrointestinal tract, but perforations have been confined to the terminal ileum and colon. We report a case of a patient who presented with peritonitis with no prodromal symptoms and who, on exploration, had multiple large jejunal perforations secondary to cytomegalovirus enteropathy.
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PMID:Multiple jejunal perforations secondary to cytomegalovirus in a patient with acquired immune deficiency syndrome. Case report and review. 253 85

Thirty of 81 consecutive HIV antibody positive patients referred with non-cryptosporidial diarrhoea had no potential infectious cause; most had AIDS related complex rather than the full blown syndrome. Opportunistic infections with cytomegalovirus (CMV), mycobacterium avium-intracellulare (MAI), and herpes simplex virus (HSV), which allowed a diagnosis of AIDS to be made, were found in 19 patients and were the presenting features of AIDS in five. Other potential pathogenic species included entamoeba, giardia, campylobacter, and salmonella (without septicaemia). Cytomegalovirus infection was often accompanied by abdominal pain. Severe weight loss (greater than 10 kg) at presentation was found in patients with CMV infection and MAI. Bloody diarrhoea was confined to the group with HSV procitis. Malignant causes of diarrhoea were rare. Two patients developed a squamous carcinoma of the anorectal margin and one a non-Hodgkin's lymphoma. In only two of 12 patients who had Kaposi's sarcoma was this considered as a cause of diarrhoea. Rigid sigmoidoscopy showed macroscopic abnormalities in over a third (32) of the 81 patients with non-cryptosporidial diarrhoea. Most commonly this was severe inflammation (17) or discrete ulceration (four) [three of whom had CMV colitis]. Kaposi's sarcoma was identified in 11 patients. Non-specific inflammation was seen histologically in 40 of the 60 patients with no sigmoidoscopic inflammatory changes. Barium enema only revealed an abnormality in a minority of the patients and a colonoscopy only revealed information additional to rigid sigmoidoscopy in two patients--one with CMV ulcers in the transverse colon and the other with evidence of Kaposi's sarcoma not seen in the rectum. Ten patients had a rectal biopsy examined by electron microscopy as no infective cause of diarrhoea was uncovered. In four of these microtubular structures which are commonly seen in viral infections were found and two had prelymphomatous changes and in one of these frank lymphoma has developed. We recommend multiple stool analysis, sigmoidoscopy and rectal biopsy as the initial investigations in these patients reserving tests of malabsorption, colonoscopy, and barium enema for the small number of more difficult cases.
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PMID:Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients. 253 10

Eighty-five patients with the acquired immunodeficiency syndrome (AIDS) were treated at Fairfield Infectious Diseases Hospital between April 1984 and June 1987. Sixty per cent of patients suffered gastrointestinal symptoms during the period of study, and in a further 15% of patients, abnormalities of the gastrointestinal tract were found incidentally. The principal manifestations were oropharyngeal ulceration, dysphagia/odynophagia, abdominal pain, diarrhoea, gastrointestinal bleeding, and perianal lesions. Opportunistic diseases involving all parts of the gastrointestinal system were encountered, the most prevalent being infections that were caused by Candida spp., cytomegalovirus, Mycobacterium avium-intracellulare and herpes simplex, and Kaposi's sarcoma. Abnormal liver-function test-results were found in 41 patients; most commonly, these were attributable to minor drug reactions, and cytomegalovirus or Myco. avium-intracellulare infection. Only one patient became jaundiced clinically. We conclude that involvement of the gastrointestinal tract is common in patients with AIDS, and that gastrointestinal lesions are an important cause of morbidity and mortality in these patients.
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PMID:The gastrointestinal and hepatic manifestations of the acquired immunodeficiency syndrome. 271 83

Two patients without risk factors or a prior history of pancreatitis developed acute pancreatitis soon after initiating pentamidine isethionate therapy for Pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome. In both patients the pancreatitis improved following medication cessation. One patient did not redevelop pancreatitis when he subsequently received inhaled pentamidine. Review of the literature revealed five previously reported cases of this drug reaction. Pentamidine-associated pancreatitis appears to develop within three weeks of initiating therapy and after receiving more than 1 g in cumulative dosage. Glucose abnormalities, renal insufficiency, and non-specific abdominal pain may be early warning signs of pentamidine-associated pancreatitis.
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PMID:Pentamidine-associated pancreatitis. 279 17

In feces referred for parasite investigation from 1973 patients of the Hospital Clinico Universitario in Salamanca, 27 instances of infestation by Cryptosporidium sp (1.5% of all investigated patients) were detected in 19 children (1.4%) and 8 adults (2.2%). The incidence in patients with antibodies against the human immunodeficiency virus (HIV) was 12.5%, in contrast with 1.25% in patients without anti-HIV antibodies. 55.5% of the instances of Cryptosporidium sp infestation were found in children less than 4 years old. The higher incidence was in winter and spring. The association with other enteropathogens was found in 14.8%. Diarrhea and abdominal pain were the most common clinical features of cryptosporidial disease. Chronic diarrhea was found in two adult patients with acquired immunodeficiency syndrome. In immunocompromised children and adults asymptomatic carriers were found. The sensitivity and specificity of immunofluorescence testing with monoclonal antibodies as compared with Ziehl-Neelsen stain for the detection of Cryptosporidium sp oocysts were 100%.
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PMID:[Incidence of Cryptosporidium sp in patients treated in a general hospital. Technics for the identification of oocysts in feces]. 279 44


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