Gastrointestinal Problems

Gastrointestinal (GI) symptoms, which include diarrhea, nausea and stomach pain, are very common among people with HIV. These symptoms can be challenging to sort out because they may be side effects of HIV therapy, related to HIV, or from GI conditions unrelated to HIV. It’s important not to ignore GI symptoms. They may need treatment to reduce symptoms, or more importantly, may be signs of a more serious underlying problem.

The GI tract is a long tube with one entrance (the mouth) and one exit (the anus), and problems can occur in any section. Keeping the GI tract healthy is important. It helps the body absorb medications, which leads to more successful HIV therapy. Controlling symptoms like nausea and diarrhea will improve quality of life and lead to better long-term treatment results.

If GI symptoms don't go away with standard therapy, it may be a sign of a more serious problem. A gastroenterologist, a specialist in diseases of the digestive system, can help find what is causing symptoms and treat them.

Some common GI problems that can affect a person with HIV include:

• Gastritis
• Gastroesophageal reflux disease, called GERD
• Heartburn
• Intestinal infections

The following GI problems are more serious for those with HIV, including:

• Anorectal infections
• Esophageal infection
• Gastrointestinal cancers
• HIV gastropathy
• HIV enteropathy
• Salmonelleosis
• A toxic reaction to HIV medications

Symptoms

The symptoms of GI problems can range from mild to serious including:

• Heartburn
• Diarrhea
• Nausea and vomiting
• Painful swallowing
• Loss of appetite
• Stomach pain, cramping and bloating
• Weight loss 

Causes

The causes of GI problems can be as simple as eating a spicy meal that leads to heartburn. Or, it can be as serious as HIV-related gastrointestinal cancer or a life-threatening reaction to HIV medications.

GI problems may be caused by many things, including:

• Infections, such as from salmonella bacteria or parasites, which pose greater risks for those with HIV and which require specific treatment.
• Side effects of HIV medications, which may require a change in medication or dosing.
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen.
• Decreased stomach acid secretions.
• A direct infection of the intestine with HIV, called HIV enteropathy.
• Unprotected anal sex, which can lead to infections in the anus or rectum.
• Gastrointestinal cancers, two of which are specifically associated with HIV: Kaposi’s sarcoma and non-Hodgkin’s lymphoma.
• Colon cancer
• Dangerous, toxic side effects of HIV medications, which may be life threatening.

No GI symptom should be ignored, especially by someone with HIV, because it may be a sign of something serious. It’s best to report any and all GI problems to a physician. 

Prevention

Some common GI problems can be prevented by:

• Washing hands often, especially before eating.
• Cooking meat and eggs fully.
• Using healthy food safety practices. Keep hot food hot and cold food cold.
• Avoiding contaminated food and drinks when traveling.
• Eating as least three hours before lying down.
• Avoiding spicy, acidic or fatty foods.
• Drinking plenty of water when taking medications in pill form.
• Limiting use of NSAIDs.
• Limiting alcohol use.

It also is important to keep the GI tract healthy while undergoing HIV treatment. A healthy GI tract helps the body absorb medications. 

Diagnosis

The range and seriousness of symptoms will help a physician decide what types of tests are needed. These may include blood tests for infections or imbalances, or procedures for looking inside the digestive tract. 

Treatment

GI symptoms in HIV are extremely common. They may have a profound effect on treatment and quality of life. It is important to keep healthcare providers informed of symptoms and the use of any over-the-counter or prescription drugs to treat them. Some of these drugs may interact with HIV medications.

GI problems can be treated once diagnosed. Managing symptoms, treating infections and adjusting medications can lead to long-term treatment success.

HIV Medication Side Effects

Overall, HIV treatment improves GI disease by improving immune function and decreasing infections. However, there are some dangers associated with HIV medications that can be life threatening. GI symptoms are often the first clue; so it is important report them to a health care provider.

These dangerous side effects include:

• Lactic acidosis is a condition linked with NRTIs, especially Videx® (didanosine), Zerit® (stavudine) and Retrovir®. NRTIs damage mitochondria, which increases the level of lactic acid in the blood. Lactic acidosis is more common in women, and may also include liver problems. Blood tests can check lactate levels if this is suspected.
• Pancreatitis is a life-threatening inflammation of the pancreas. It occurs most often with Videx, Bactrim, and pentamidine.
• Hepatic necrosis (sudden liver failure) has been caused by Viramune® (nevirapine), particularly during the first four-and-a-half months of treatment. Although very rare, women with CD4 counts above 250, men with CD4 counts above 400, pregnant women, and those with chronic hepatitis B or C are most at risk.