Enfoque de la diarrea en pacientes infectados con VIH
DOI:
https://doi.org/10.22516/25007440.192Palabras clave:
Diarrea, Virus de inmunodeficiencia humana, VIH, Antirretrovirales, Enteropatía por VIHResumen
La diarrea es el síntoma gastrointestinal más frecuente en las personas infectadas por el virus de la inmunodeficiencia humana. La diarrea puede aparecer como consecuencia de infección por un germen oportunista, así como ser un efecto secundario del tratamiento antirretroviral. Esta puede a su vez ser aguda o crónica, siendo esta ultima la que conlleva a mayor morbilidad y alteración en la calidad de vida del paciente. El enfoque diagnostico se realiza por etapas que van desde una historia clínica completa, hasta estudios de tipo microbiológicos, endoscópicos y de imágenes. Finalmente, si se han descartado causas infecciosas u orgánicas (enteropatía idiopática), se brindará manejo al paciente, buscando alivio sintomático y optimizando la adherencia al tratamiento antirretroviral.
Descargas
Lenguajes:
esReferencias bibliográficas
Logana C, Beadswortha BJ, Beeching N. HIV and diarrhoea: what is new?. Curr Opin Infect Dis 2016, 29:486–494.
MacArthur RD, DuPont HL. Etiology and Pharmacologic Management of Noninfectious Diarrhea in HIV-Infected Individuals in the Highly Active Antiretroviral Therapy Era. Clin Infect Dis. 2012 Sep;55(6):860-7.
Feasey NA, P. Healey P, Gordon MA. Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient. Aliment Pharmacol Ther. 2011 Sep;34(6):587-603.
Andrade FM. Quiroga A. Builes C. Saldarriaga C. Aguilar C. Mesa M et al. Epidemiología de la infección por el virus de inmunodeficiencia humana en pacientes hospitalizados en una institución de alta complejidad y enseñanza universitaria en Medellín, Colombia. Infectio. 2016;20(1):9---16
Flórez AC. García DA. Moncada L. Beltrán M. Prevalencia de microsporidios y otros parásitos intestinales en pacientes con infección por VIH, Bogotá, 2001. Biomédica 2003;23:274-82
Shah S, Kongre V, Kumar V, Bharadwaj R. A Study of Parasitic and Bacterial Pathogens Associated with Diarrhea in HIV-Positive Patients. Cureus. 2016 Sep 27;8(9):e807
Oude Munnink BB, Canuti M, Deijs M, de Vries M, Jebbink MF, Rebers S et al. Unexplained diarrhoea in HIV-1 infected individuals. BMC Infect Dis. 2014 Jan 13;14:22
Krones E, Högenauer Ch. Diarrhea in the Immunocompromised Patient. Gastroenterol Clin North Am. 2012 Sep;41(3):677-701
Fernández-Cruz A, Muñoz P, Mohedano R, Valerio M, Marín M, Alcalá L et al. Campylobacter bacteremia: clinical characteristics, incidence, and outcome over 23 years. Medicine (Baltimore) 2010;89:319–30
Hohmann EL. Nontyphoidal salmonellosis. Clin Infect Dis 2001;32:263–9.
Wilcox CM. Gastrointestinal consequences of infection with human immunodeficiency virus. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtrans’s Gastrointestinal and Liver Disease. vol. 1. Philadelphia: Elsevier Saunders; 2010. p. 526–30
Burgers WA, Riou C, Mlotshwa M, Maenetje P, de Assis Rosa D, Brenchley J, et al. Association of HIV-specific and total CD8 1 T memory phenotypes in subtype C HIV-1 infection with viral set point. J Immunol 2009;182:4751–61.
Wallace JM, Hannah JB. Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome. A clinicopathologic study. Chest 1988;93:926–32.
Gordin FM, Cohn DL, Sullam PM, Schoenfelder JR, Wynne BA, Horsburgh CR Jr, et al. Early manifestations of disseminated Mycobacterium avium complex disease: a prospective evaluation. J Infect Dis 1997;176:126–32
Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int 2011;2011:247923
Gordon SN, Cervasi B, Odorizzi P, Silverman R, Aberra F, Ginsberg G, et al. Disruption of intestinal CD4 1 T cell homeostasis is a key marker of systemic CD4 1 T cell activation in HIVinfected individuals. J Immunol 2010;185:5169–79
Loo VG, Bourgault AM, Poirier L, Lamothe F, Michaud S, Turgeon N, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011;365:1693–703
Deshpande A, Pasupuleti V, Rolston DD, Jain A, Deshpande N, Pant C, et al. Diagnostic accuracy of real-time polymerase chain reaction in detection of Clostridium difficile in the stool samples of patients with suspected Clostridium difficile infection: a meta-analysis. Clin Infect Dis 2011;53:e81–90
Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–31
Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis 2010;16:1620–7.
Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002;34:1094–7
Huston CD. Intestinal protozoa. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtrans’s Gastrointestinal and Liver Disease. vol. 2. Philadelphia: Elsevier Saunders; 2010. p. 1914–8.
Ma P. Cryptosporidiosis and immune enteropathy: a review. Curr Clin Top Infect Dis 1987;8:99–153
Rossignol JF. Nitazoxanide in the treatment of acquired immune deficiency syndrome-related cryptosporidiosis: results of the United States compassionate use program in 365 patients. Aliment Pharmacol Ther 2006;24:887–94.
Silva CV, Ferreira MS, Borges AS, Costa-Cruz JM. Intestinal parasitic infections in HIV/AIDS patients: experience at a teaching hospital in central Brazil. Scand J Infect Dis 2005;37:211–5.
Concha R, Harrington W Jr, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 2005;39:203–11
Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother 2007;41:1992–2001
Casotti JA, Motta TQ, Ferreira CU Jr, Cerutti Jr C.. Disseminated histoplasmosis in HIV positive patients in Espirito Santo state, Brazil: a clinical-laboratory study of 12 cases (1999-2001). Braz J Infect Dis 2006;10:327–30
Assi M, McKinsey DS, Driks MR, O'Connor MC, Bonacini M, Graham B, et al. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review. Diagn Microbiol Infect Dis 2006;55:195–201
Kartalija M, Sande MA. Diarrhea and AIDS in the era of highly active antiretroviral therapy. Clin Infect Dis 1999;28:701–5
Cello JP, Day LW. Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens. Gastroenterology 2009;136:1952–65
O’Brien ME, Clark RA, Besch CL, Myers L, Kissinger P , et al. Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort. J Acquir Immune Defic Syndr 2003;34:407–14
Wu X, Sun L, Zha W, Studer E, Gurley E, Chen L, et al. HIV protease inhibitors induce endoplasmic reticulum stress and disrupt barrier integrity in intestinal epithelial cells. Gastroenterology 2010;138:197–209
MacArthur R. Management of Noninfectious Diarrhea Associated With HIV and Highly Active Antiretroviral Therapy. Am J Manag Care. 2013;19(11 suppl):S238-S245
National Institute of Allergy and Infectious Diseases. Division of AIDS table for grading the severity of adult and pediatric adverse events. Division of AIDS Regulatory Support Group website. Disponible en: URL: http://rsc.tech-res.com/docs/default-source/safety/daids_ae_grading_table_v2_nov2014.pdf
Public Health England. Investigation of specimens other than blood for parasites. NHS 2017. Disponible en: URL: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/622944/B_31i5.1.pdf
American Society for Gastrointestinal Endoscopy. The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc. 2010 May;71(6):887-92
Cohen J, West AB, Bini EJ. Infectious diarrhea in human immunodeficiency virus. Gastroenterol Clin North Am. 2001 Sep;30(3):637-64
Olmos MA, Losso M, Ruvinsky S, Velázquez A, Augustovski F. Decision analysis: diagnostic approach in HIV infection associated chronic diarrea. Acta Gastroenterol Latinoam. 2005;35(3):155-61
Wilcox M, Schwartz D, Cotsonis G, Thompson III S. Chronic Unexplained Diarrhea in Human Immunodeficiency Virus Infection: Determination of the Best Diagnostic Approach. Gastroenterology 1996;110:30–37
Kearney DJ, Steuerwald M, Koch J, Cello JP. A prospective study of endoscopy in HIV -associated diarrea. Am J Gastroenterol. 1999 Mar;94(3):596-602
Wei SC, Hung CC, Chen MY, Wang CY, Chuang CY, Wong JM. Endoscopy in acquired immunodeficiency syndrome patients with diarrhea and negative stool studies. Gastrointest Endosc. 2000;51(4 Pt 1):427
Orenstein JM, Dieterich DT. The Histopathology of 103 Consecutive Colonoscopy Biopsies From 82 Symptomatic Patients With Acquired Immunodeficiency Syndrome. Arch Pathol Lab Med. 2001 Aug;125(8):1042-6
Bini EJ, Cohen J. Diagnostic yield and cost-effectiveness of endoscopy in chronic human immunodeficiency virus-related diarrea. Gastrointest Endosc. 1998 Oct;48(4):354-61
Oette M, Stelzer A, Göbels K, Wettstein M, Sagir A, Feldt T, Häussinger D. Wireless capsule endoscopy for the detection of small bowel Diseases in HIV-1-infected patients. Eur J Med Res. 2009 May 14;14(5):191-4
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics 2007; 27: 1255–73.
Restrepo CS, Martinez S, Lemos JA et al. Imaging manifestations of Kaposi sarcoma. Radiographics 2006; 26: 1169– 85.
Ghai S, Pattison J, O’Malley ME, Khalili K, Stephens M. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 2007; 27: 1371–88.
Hill A, Balkin A. Risk factors for gastrointestinal adverse events in HIV treated and untreated patients. AIDS Rev. 2009; 11(1):30-38.
Clay PG, Crutchley RD. Noninfectious Diarrhea in HIV Seropositive Individuals: a Review of Prevalence Rates, Etiology, and Management in the Era of Combination Antiretroviral Therapy. Infect Dis Ther. 2014 Dec;3(2):103-22
Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIVinfection: review of weight loss and wasting in the era of highly active antirretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis. 2006;42:836–42
Anastasi JK, Capili B, Kim AG, McMahon D, Heitkemper MM. Symptom management of HIVrelated diarrhea by using normal foods: a randomized controlled clinical trial. J Assoc Nurses AIDS Care. 2006;17:47–57.
Huffman FG, Walgren ME. L-glutamine supplementation improves nelfinavir-associated diarrhea in HIV-infected individuals. HIV Clin Trials. 2003;4:324–9
Anukam KC, Osazuwa EO, Osadolor HB, Bruce AW, Reid G. Yogurt containing probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 helps resolve moderate diarrhea and increases CD4 count in HIV/ AIDS patients. J Clin Gastroenterol. 2008;42:239–43
Salminen MK, Tynkkynen S, Rautelin H, Poussa T, Saxelin M, Ristola M, et al. The efficacy and safety of probiotic Lactobacillus rhamnosus GG on prolonged, noninfectious diarrhea in HIV patients on antiretroviral therapy: a randomized, placebo-controlled, crossover study. HIV Clin Trials. 2004;5:183–91
Hummelen R, Changalucha J, Butamanya NL, Koyama TE, Cook A, Habbema JD, et al. Effect of 25 weeks probiotic supplementation on immune function of HIV patients. Gut Microbes. 2011;2:80–5.
Nwachukwu CE, Okebe JU. Antimotility agents for chronic diarrhoea in people with HIV/AIDS. Cochrane Database Syst Rev 2008; 4:CD005644
Sherman DS, Fish DN. Management of protease inhibitor-associated diarrhea. Clin Infect Dis. 2000;30:908–14.
Cello JP, Grendell JH, Basuk P, Simon D, Weiss L, Wittner M, et al. Effect of octreotide on refractory AIDS-associated diarrhea. A prospective, multicenter clinical trial. Ann Intern Med. 1991;115:705–10
Beaugerie L, Baumer P, Chaussade S, Berard H, Rozenbaum W, Pialoux G, et al. Treatment of refractory diarrhoea in AIDS with acetorphan and octreotide: a randomized crossover study. Eur J Gastroenterol Hepatol. 1996;8:485–9.
Castro JG, Chin-Beckford N. Crofelemer for the symptomatic relief of non-infectious diarrhea in adult patients with HIV/AIDS on anti-retroviral therapy. Expert Rev Clin Pharmacol. 2015;8(6):683-90.
Leonard C, Chordia P, MacArthur RD. Profile of crofelemer for the symptomatic treatment of diarrhea in HIV-infected persons. Botanics Target Ther 2015;5:21-5
Crutchley RD, Miller J, Garey KW. Crofelemer, a novel agent for treatment of secretory diarrhea. Ann Pharmacother 2010;44(5):878-84
Macarthur RD, Hawkins TN, Brown SJ, Lamarca A, Clay PG, Barrett AC, et al. Efficacy and safety of crofelemer for noninfectious diarrhea in HIV-seropositive individuals (ADVENT trial): a randomized, double-blind, placebo-controlled, two-stage study. HIV Clin Trials 2013;14(6):261-73
Hawkins T, MacArthur RD, Brown SJ, Clay P, Waldman L, Barrett AC, et al. Safety and tolerability of crofelemer 125 mg twice daily in the treatment of noninfectious diarrhea in HIV-seropositive patients on antiretroviral therapy: results from a Phase 3, 48-week open-label study Poster 1505. IDWeek; 2–6 October 2013; Francisco, CA
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Estadísticas de artículo | |
|---|---|
| Vistas de resúmenes | |
| Vistas de PDF | |
| Descargas de PDF | |
| Vistas de HTML | |
| Otras vistas | |
