Human Immunodeficiency Virus–Related Gastrointestinal Pathology: A Southern Africa Perspective With Review of the Literature (Part 1: Infections)

Abstract

Context.—Human immunodeficiency virus infection is rife in sub-Saharan Africa and in southern Africa in particular. Despite the increasing availability of antiretroviral therapy in this region, opportunistic infections remain common and frequently involve the gastrointestinal tract. Objective.—To review the histopathologic findings and distinguishing features of human immunodeficiency virus–associated gastrointestinal infections in southern Africa and relate those findings to the documented international literature. Data Sources.—The available literature on this topic was reviewed and supplemented with personal experience in a private histopathology practice in South Africa. Conclusions.—In southern Africa, the range of gastrointestinal, opportunistic infectious pathology in human immunodeficiency virus afflicted patients is diverse and includes viral, bacterial, fungal, and parasitic infections. This infectious pathology is sometimes a manifestation of systemic disease. In profoundly immunocompromised patients, unusual histologic features, involvement of uncommon gastrointestinal tract sites, and more than one pathogen may be seen.

Humanized HLA-DR4 Mice Fed with the Protozoan Pathogen of Oysters Perkinsus Marinus (Dermo) Do Not Develop Noticeable Pathology but Elicit Systemic Immunity

“…Gastrointestinal infections and allergic reactions to food components are characterized by histological alterations in the gut architecture commonly due to disruption of the gastrointestinal epithelium and/or leukocyte infiltration [47], [48]. Gastrointestinal pathogens can also induce pulmonary pathology due to the close proximity of the esophagus and trachea.…”

Navigating the jungles of tropical infectious gastrointestinal pathology: a pattern-based approach to the endoscopic biopsy

“…Interestingly, the traveller's risk for contracting Helicobacter pylori-associated gastritis, which has an extremely high prevalence in developing countries and where co-infection with non-pylori Helicobacter spp. is frequent, is not increased [14][15][16].…”

“…The microsporidial organisms Enterocytozoon bieneusi and Encephalitozoon intestinalis are traditionally still included in this group, although recently reclassified as fungi [31]. The coccidians are common in tropical and subtropical countries, especially those with a high HIV burden, and are increasingly recognised as a cause of traveller's diarrhoea [14,32,33]. Infection in immunocompetent patients is usually asymptomatic or mild and self-limiting.…”

CD14+ macrophages that accumulate in the colon of African AIDS patients express pro-inflammatory cytokines and are responsive to lipopolysaccharide

“…Clinical manifestations of HIV infection in the gastrointestinal tract include malabsorption, diarrhea and a wasting syndrome [ 18 – 21 ]. Diarrhea accompanied by wasting (“slims disease”) is responsible for a significant amount of HIV-related morbidity in sub-Saharan Africa [ 22 ], even in the era of ART [ 23 , 24 ]. Opportunistic infections (OIs) are a common cause of these disorders in HIV-infected individuals and include a range of viral, bacterial, fungal and parasitic pathogens [ 24 ].…”

“…Diarrhea accompanied by wasting (“slims disease”) is responsible for a significant amount of HIV-related morbidity in sub-Saharan Africa [ 22 ], even in the era of ART [ 23 , 24 ]. Opportunistic infections (OIs) are a common cause of these disorders in HIV-infected individuals and include a range of viral, bacterial, fungal and parasitic pathogens [ 24 ]. Cotrimoxazole prophylaxis is a mainstay for the prevention of OIs in Africa and other resource limited settings and is recommended for severely immunocompromised HIV-infected individuals [ 25 ].…”