DIGESTIVE-TRACT DISORDERS IN PATIENTS INF ECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Dysphagia or odynophagia occurs in an estimated 21% of patients with h uman immunodeficiency virus infection, A causal agent can be identifie d in 60-90% of the cases and generally can be successfully eradicated, Oesophageal candidosis, the predominant disorder, usually responds to nitrate derivatives and amphotericine B after a 10 to 15 day cure. Ul cerations of the oesophagus is the second major cause of dysphagia in these patients and result from cytomegalovirus and herpes simplex infe ctions or unknown causes. Epstein-Barr virus infection has been sugges ted but is rarely demonstrated in clinical situations. Similar to othe r localizations in HIV-infected patients, Kaposi sarcoma and non-Hodgk in malignant lymphomas are the predominant tumours in the bowel, Infec tions are essentially revealed by sometimes very severe diarrhoea, Inf ective agents include Cryptosporidium parvum, microsporidiosae, cytome galovirus, adenovirus, Isospora belli, Clostridium difficile, Salmonel lae and non-tuberculous mycobacteria among others, When the search for an infective agent is negative, the diarrhoea is usually considered t o be the expression of HIV infection itself. The clinical approach to HIV related diarrhoea can be based on decision making management schem e according to the results of stool cultures or on complete exploratio n protocols, Whatever the diagnostic procedure, symptomatic treatment is of major importance because of the severe nutritional impact of HIV -related diarrhoea.