HIV and AIDS News & Information

Gastrointestinal and hepatobiliary disorders are among the most frequent complaints in patients with HIV disease. Effective antiretroviral therapy and chemoprophylaxis (PCP, MAC, and CMV) has significantly reduced the occurrence of gastrointestinal opportunistic infections.

Diarrhea

Diarrhea is the most common GI symptom in patients with HIV, affecting 0.9 to 14% of outpatients. Protozoal, viral, and bacterial organisms may cause diarrhea in patients with AIDS. MAC and CMV infections are observed in patients with CD4 cell count <100/mm3. Pathogen-negative diarrhea is the cause of the most cases of diarrhea in this patient group.  Continue Reading »

There have been three-quarters of a million persons reported with AIDS in the United States, and there have been more than one-third of a million deaths. About 8,000 children have been infected, more than half of whom have died.

Several important changes have occurred in the demographic profile of people with AIDS. There has been an increasing impact of the epidemic on minority groups in this country. Persons with AIDS have been gradually decreasing as a proportion of all HIV cases, with corresponding increases among Hispanic persons and also African-Americans. African-American and Hispanic persons taken together now account for about two-thirds of all persons recently reported with AIDS, and about 80% of all women recently reported with AIDS.

The proportion of cases in women is gradually increasing, and about 22% of all people reported with AIDS are women.

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HIV-associated, non-Hodgkin’s lymphoma occurs in 5-10% of individuals with HIV infection. The incidence of lymphoma in this population has been rising and may reflect prolonged survival related to the use of highly-active antiretroviral therapy and infection prophylaxis.

Pathophysiology

HIV-associated non-Hodgkin’s lymphomas are virtually all of B-cell origin. Most are intermediate- or high-grade lymphomas categorized as large cell (60%) or small non-cleaved lymphomas (25%).

Seventy-five percent of patients with systemic lymphoma have a CD4 cell count>50/mm3. Most present with extranodal disease, often in the bone marrow, meninges, liver or GI tract.

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A. Neutropenia occurs in half of all patients with advanced HIV infection. Causes include myelosuppressive medications, opportunistic infections or neoplasms, HIV-induced myelosuppression, deficient production of myeloid growth-stimulating factors, and depletion of hematopoietic progenitor cells.

B. Neutropenia may cause an increased incidence of infections, hospitalization, decreased survival, and discontinuation of medications (or use of suboptimal dosages).

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II. Anemia

A. Twenty five percent of patients with AIDS develop severe anemia (hemoglobin <8 g/dl). Anemia is caused HIV-related hematopoietic defects and by zidovudine therapy. Milder forms of anemia develop in 50% of all patients with HIV disease (hemoglobin 8-13 g/dl). The frequency and severity of zidovudine-induced anemia increases with higher dosages and with later stages of HIV disease.

B. Severe anemia often requires dose adjustment of zidovudine and other myelosuppressive therapies. Blood transfusions should be avoided because increased immunosuppression and exposure to possible blood-born infections often results.

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HIV-infected patients frequently develop hematologic abnormalities. Cytopenias often respond to suppression of HIV with antiretrovirals, treatment of infectious diseases and tumors, discontinuation or dosage reduction of myelosuppressive medications, correction of nutritional deficiencies, and treatment with hematopoietic growth factors or other cytokines.

I. Thrombocytopenia

A. Causes of thrombocytopenia include myelosuppression from medications, infections or tumors and increased destruction of cells (disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, immune mediated thrombocytopenia). Platelet counts may respond to anti-HIV therapy with antiretroviral drugs, immunoglobulin therapy, splenectomy, vincristine, prednisone, danazol, or alpha interferon.

B. Discontinuation of myelosuppressive medications and treatment of infections and tumors may also reduce thrombocytopenia. Plasma exchange has been effective for TTP.