Gastrointestinal Complications Of Hiv Disease
Diseases of the gastrointestinal tract are common among those who are HIV-infected. Sometimes the first clue that a previously undiagnosed inmate/patient is HIV-infected is the presence of an HIV-associated gastrointestinal condition. These conditions can lead to significant morbidity including pain, difficulty swallowing, diarrhea, and weight loss. Early diagnosis and treatment can substantially improve the lives of those who are afflicted by these conditions. Although identifying the specific etiology of a patient’s symptoms can be challenging, a methodical approach can usually identify a treatable condition. This article focuses on some of the most common abnormalities of the gastrointestinal system that correctional health care providers are likely to encounter among their HIV-infected patients.
Gastrointestinal Problems And Hiv
Gastrointestinal symptoms — diarrhea, nausea, and stomach pain — are among the most common problems that affect people with HIV. These symptoms can be challenging to sort out, as they can occur as side effects of HIV therapy and due to GI conditions related and unrelated to HIV. Try not to ignore GI symptoms — they could be signs of a more serious underlying problem or require treatment for symptom relief.
Make keeping the gut healthy a priority for you and your healthcare provider — successful HIV therapy depends on it! A healthy GI tract is necessary for proper absorption of medications. And controlling symptoms like nausea and diarrhea will improve your quality of life and help you adhere to your medications, causing better long-term treatment outcomes.
If GI symptoms persist and don’t go away with standard therapy, it may be the sign of a more serious problem. Your provider may refer you to a gastroenterologist, a specialist in diseases of the digestive system, including the liver.
Adapted from Johns Hopkins University Pocket Guide to Adult HIV/AIDS Treatment by John Bartlett, MD, www.aidsmeds.com, and other sources.
What Can Cause It
Your pain may come from different places:
The HIV itself. The virus can damage nerves throughout your body. That can cause intense pain. Nerve pain is the most common pain when you have HIV.
Another illness. HIV weakens your immune system. This means youâre more likely to get new infections, such as hepatitis or pneumonia. And old infections, like herpes, may come back. One type of herpes virus causes shingles — a burning rash along nerve pathways. For some people, the pain of shingles can last long after the rash goes away.
Side effects from your medicine. HIV drugs called antiretrovirals, or ARVs, can cause long-term side effects, like diabetes, bone loss andfractures, and painful rashes.
Sometimes, all three play a role.
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What Is Human Immunodeficiency Virus
Human immunodeficiency virus is a virus that attacks the body’s immune system, which is responsible for fighting infections. People with untreated HIV infection dont fight off infections or cancer as well as healthy people and they can become sick easily.
Acquired immune deficiency syndrome describes the late stage of HIV infection. In the U.S., most people infected with HIV do not go on to develop AIDS because HIV medicines are available that can stop the progression of the disease.
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Infections Of The Small Intestine
The symptoms associated with enteritis are typically associated with diarrhea and prolonged malabsorption leading to malnutrition. This is generally because of opportunistic infections, and, similar to other pathologies in HIV patients, the incidence of enteritis has decreased in the highly active antiretroviral therapy era. The main symptoms of enteritis are copious voluminous diarrhea with dehydration and malabsorption, as opposed to colitis, which is a bloody, painful diarrhea. The work-up of enteritis is detailed above, but specifically should include stool studies, and, if non-diagnostic, esophagogastroduodenoscopy with biopsy. The etiologies of enteritis in HIV patients are multifold, and include bacterial, viral, fungal, and parasitic pathogens. These can be diagnosed by the stool studies detailed earlier.
How Is Human Immunodeficiency Virus Diagnosed
Human immunodeficiency virus is diagnosed with either a blood test or a saliva test.
Rapid HIV test results are available in minutes, though some test results can take days.
There are also HIV test kits available at some pharmacies that can be used at home. One test uses a special strip to collect a small amount of blood, and another kit has a strip that is wiped on the gums. The strips are mailed to a lab for testing. If you use an at-home HIV test kit and results come back positive, see your doctor.
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Is There A Cure
In 2008, scientists reported that Timothy Ray Brown, an American living in Berlin, was effectively “cured” of HIV following an experimental stem cell transplant. Despite the promise of a cure, the procedure proved highly risky, and subsequent attempts to repeat the results were either mixed or failed.
To date, only three other people have been declared “cured” of HIV. Even so, the insights gained from Brown and the others provided a general template for HIV cure research.
Today, scientists are largely focused on a “kick-kill” strategy. This involves designing medications able to “kick” HIV out of its hidden reservoirs, followed by drugs, vaccines, or immunotherapies that can effectively “kill” the newly released viruses. Research is ongoing.
Other scientists are focused on developing a “functional cure” for HIV. This is a vaccine that doesn’t eradicate HIV but instead prevents it from progressing without the need for antiretroviral drugs.
Listening To The Gi Tract: Clues To Three Dangerous Toxicities Of Hiv Medications
The medication side effects described above can get in the way of good adherence and may disrupt your daily life. But there are some toxicities associated with HIV medications that can be life-threatening. Your first clue to these serious problems may be GI symptoms, so your best bet is to report any and all GI side effects to your provider.
Lactic Acidosis
Lactic acidosis is a condition associated with NRTIs, especially Videx and Zerit , but Retrovir as well. NRTIs damage mitochondria, which are inside all human cells and use oxygen, fat, and sugar to produce energy for the cells. Mitochondrial damage leads to excess lactate production, which drives up the level of lactic acid in the blood. Lactic acidosis is more common in women, and it may be accompanied by liver abnormalities, including fatty liver. Symptoms of lactic acidosis may include decreased appetite, nausea, vomiting, or abdominal pain, although many people who experience the condition may not experience or notice the symptoms right away. Your provider can run tests to check the level of lactate in your blood if he or she suspects lactic acidosis.
Pancreatitis
Some HIV medications can cause pancreatitis, an inflammation of the pancreas that is life-threatening. This condition most frequently occurs with Videx , Bactrim, and pentamidine . Pancreatitis can cause abdominal pain which radiates to the back and is worst after eating, sometimes accompanied by nausea and vomiting.
Hepatic Necrosis
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A Look At The Types Of Pains
Myopathy:
A muscle disorder that ultimately results in severe weakness, myopathy results in musculoskeletal pain which occurs in lower parts of the body like hips, back, and lower limbs.
Causes of Myopathy:
It cannot be termed as one of the main causes of myopathy, but it is said that usage of raltegravir, elvitegravir, and dolutegravir can also lead to the pains and cause fatigue as well as muscle weakness.
The pains can be stopped after discontinuing any combination of drugs. But when an antiretroviral therapy is in progress, then discontinuation will not be an option.
The Effects Of Hiv On The Body
Most people are likely familiar with HIV, but they may not know how it can affect the body.
HIV destroys CD4 cells , which are critical to the immune system. CD4 cells are responsible for keeping people healthy and protecting them from common diseases and infections.
As HIV gradually weakens the bodys natural defenses, signs and symptoms will occur.
Find out what happens when the virus enters the body and interrupts its systems.
Once HIV enters the body, it launches a direct attack on the immune system.
How quickly the virus progresses will vary by:
- a persons age
- how quickly theyre diagnosed
The timing of their treatment can make a huge difference as well.
HIV targets the types of cells that would normally fight off an invader such as HIV. As the virus replicates, it damages or destroys the infected CD4 cell and produces more virus to infect more CD4 cells.
Without treatment, this cycle can continue until the immune system is badly compromised, leaving a person at risk for serious illnesses and infections.
Acquired immunodeficiency syndrome is the final stage of HIV. At this stage, the immune system is severely weakened, and the risk of contracting opportunistic infections is much greater.
However, not everyone with HIV will go on to develop AIDS. The earlier a person receives treatment, the better their outcome will be.
Early on, HIV symptoms may be mild enough to be dismissed.
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Pain In People Living With Hiv
Pain is very common amongst people living with HIV, especially older people. Its not yet understood if people living with HIV are at greater risk of experiencing persistent pain than people without HIV, or why that might be.
The causes of pain in people living with HIV are varied and are not all connected to HIV. However, there are factors that may be specific to people living with HIV and influence their experience of pain.
Biological causes related to HIV may include infections, cancers, gut problems, and nerve damage, such as peripheral neuropathy. Many of these conditions can be avoided by starting HIV treatment before your immune system is too damaged . Nerve damage is not usually reversible, although symptoms can be managed. You can read more about peripheral neuropathy and how it is diagnosed here.
Pain in multiple parts of the body also seems to be common in people with HIV. Although the exact causes are unclear, this widespread pain may be related to length of time living with HIV, taking HIV treatment, and/or living with a low CD4 count.
The drugs most commonly used in routine HIV treatment these days are much less likely to cause painful side-effects. However, even the latest anti-HIV drugs can cause some pain, such as muscle pain or headache, or make you feel generally unwell. If you have concerns about side-effects, it is important to talk to your doctor about them, so you can choose the best treatment for you.
Figuring Out The Cause
Everyone has the occasional muscle ache, especially as they age. And many people who exercise or play sports know the benefits of stretching to counteract muscle tightness that comes with physical activity. But people with HIV can experience more serious muscle conditions, including muscle pain, muscle cramping and muscle disorders that result in weakness. The pain often involves the back, hips or lower limbs.
In order to distinguish between minor and more severe muscle problems, it is very important to visit your doctor when any muscle problems develop. This is not a time for self-diagnosis. Your muscle problem could be something relatively minor, but it could also be the result of a serious problem only a doctor can properly diagnose.
Tell your doctor about any muscle weakness, aches or pains you develop so that a proper workup can determine the cause. In particular, it is very important to rule out any neurologic diseases that could be causing your symptoms.
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Body Pains That May Be An Early Sign Of Hiv
This is an article by Cara Smith. I offer it with the authors permission for informational purposes. The author and I have no financial involvement.
THE VIEWS EXPRESSED BY THE AUTHOR ARE HER OWN AND DO NOT REPRESENT MY VIEW OR MEDICAL ADVICE.
Photo by Kat Love on Unsplash
HIV is a disease that scratches out the immunity system and makes a person vulnerable to more opportunistic diseases which kill the person and not the HIV.
A person who is diagnosed with an HIV faces numerous health issues that affect both physiological and bodily aspects of the person.
One of the most serious symptoms that can raise an HIV alarm is severe body pains at poles of the body.
More Tips For Coping With Back Pain
If you have HIV, the following tips may help to minimize your back pain:
- talk with your doctor to get proper treatment as soon as possible
- limit the time you sit and take frequent breaks to walk around
- avoid lifting heavy objects with your back rounded
Its important to note that the use of opioids can potentially to lead to substance misuse which can then lead to addiction. So when prescribed, your doctor will carefully monitor your use of these medications.
Pain caused by HIV is often treatable if you work with your doctor. But the outlook of your pain depends on many factors, such as:
- underlying cause of your pain
- severity of your pain
- how far along the HIV infection has progressed
If your medications are contributing to your pain, changing them may help relieve discomfort. However, you shouldnt stop taking any of your medications without first consulting your doctor.
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Disorders Of The Esophagus
The GI tract is a long tube with one entrance and one exit , and problems can occur in any section on the way down. The esophagus is the part of the tube between the mouth and the stomach. The muscles of the esophagus contract and relax to propel food down. A muscular valve at the base of the esophagus closes off the stomach so that its acidic contents can’t leak back up into the esophagus.
Heartburn — a burning sensation behind the center of the ribcage — occurs when stomach contents travel back up the esophagus. If you experience heartburn, it usually happens thirty to sixty minutes after eating and is sometimes accompanied by a sour taste in the mouth. Heartburn can be prevented by waiting at least three hours after meals to lie down, by elevating the head of the bed or using extra pillows in bed, and by avoiding spicy or acidic foods. Other lifestyle changes to help prevent heartburn include maintaining a healthy weight and avoiding tight belts or pants.
Frequent heartburn is a side effect of some HIV medications. It may also be a sign of gastroesophageal reflux disease, called GERD for short. GERD can damage the lining of the esophagus and lead to other complications. Frequent heartburn should be discussed with your healthcare provider, as inexpensive, over-the-counter treatments are available. Further testing by your provider, including looking down the esophagus with a camera , may be necessary if the symptoms don’t go away.
Other Symptoms Of Gerd
Treatments for GERD may include:
- antacids for very mild symptoms
- over-the-counter proton pump inhibitors that reduce the acid production in your stomach
- OTC H2 blockers, which also reduce your stomachs acid production
- prescription-strength H2 blockers
- prescription-strength proton pump inhibitors
- motility drugs, which are prescription drugs that help your stomach empty faster so theres less time for reflux to occur
- prescription mucosal protectors, such as sucralfate
Talk with a doctor about which of these options may help reduce acid production that can harm your esophagus as well as help relieve your stomach pain.
Also ask a doctor about possible side effects of different treatments. For example, proton pump inhibitors may upset your stomach.
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Nausea Vomiting And Diarrhea
When it comes to side effects of HIV medications, the gut is one of the most commonly affected areas in the body. Nausea, vomiting, and diarrhea are three ways in which the gut keeps toxins like bacteria, viruses, and even medications out of the body.
These side effects dont occur in everyone, and fortunately when they occur as side effects of HIV treatment, they are usually mild and tend to diminish after the first few days or weeks of starting treatment. Even so, they can seriously impact your quality of life, and they need to be addressed as a part of your overall health so you can get the most out of your treatment.
However, if nausea, diarrhea, and vomiting are severe or ongoing, they can prevent HIV meds from entering the bloodstream and doing what they need to do. Report these symptoms to your doctor to determine if they are a side effect or a symptom of something more serious.
Nausea and Vomiting
Two of the most common gut-related side effects of HIV treatment are nausea and vomiting. Most people living with HIV who experience these usually do so after starting a new regimen. In most cases, these side effects eventually lessen or go away completely after the first few days or weeks of treatment.
Other tips to ease nausea:
Diarrhea
Here are a few tips for managing diarrhea:
Adjust your diet. Some foods can cause or worsen diarrhea, while others can help to relieve it.
Last Reviewed: February 2, 2022
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