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Colon

Infectious colitis

HIV/AIDS associated

Author: Nalini Bansal, M.D.

Editorial Board Member: Raul S. Gonzalez, M.D.

Last author update: 1 July 2017

Last staff update: 11 March 2025

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PubMed Search: HIV/AIDS colitis

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Table of Contents

Cite this page: Bansal N. HIV/AIDS associated. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonHIV.html. Accessed April 1st, 2025.

Definition / general

Major causes of gastrointestinal disease in patients who are infected with HIV are opportunistic infections and AIDS associated neoplasms (Radiology 1992:184:761, Arch Pathol Lab Med 2012;136:305)
Most opportunistic infections happen when the CD4+ T cell count is less than 200/mm³
CMV infection is the most common opportunistic infection of the bowel (Saudi J Gastroenterol 2009;15:95)
Other protozoal, viral and bacterial pathogens that can cause opportunistic infections are: cryptosporidium, cyclospora, entamoeba, giardia, herpes, isospora, microsporidia, mycobacteria, parasites, salmonella, shigella, strongyloides
Kaposi sarcoma and non-Hodgkin lymphoma (NHL) were the most common AIDS defining malignancies (Arch Pathol Lab Med 2012;136:305)
Primary HIV infection of the gastrointestinal tract has also been described in absence of any known etiological agent

Essential features

Gastrointestinal tract is a major site for HIV replication; virus localizes in gastric mucosal tissue and depletes CD4+ T cells

Terminology

AIDS colitis

ICD coding

AIDS (related complex) B20

Epidemiology

HIV colitis occurs predominantly in homosexual men; affected individuals range from 26 to 54 years of age (AJR Am J Roentgenol 1997;168:681)

Sites

Can occur anywhere in gastrointestinal tract

Pathophysiology

Gastrointestinal tract is a major site of HIV replication
HIV virus localizes and replicates in gut associated lymphoid tissues (GALT) and specifically targets mucosal CD4+ lymphocytes
Constant viral replication result in depletion of CD4+ lymphocyte count, leading to secondary opportunistic infections (Immunol Rev 2013;254:54)
With advanced HIV, there are markedly reduced numbers of CD4+ cells along with a parallel increase in CD8+ T cells (Gastroenterology 1986;91:651)
There are also significant increases in levels of inflammatory cytokines IL1β and IFN ϒ but a decrease in the levels of IL10 (AIDS 1994;8:461)

Etiology

HIV virus

Diagrams / tables

Images hosted on other servers:

HIV associated damage to the GI tract

Clinical features

Chronic diarrhea, abdominal pain, rectal bleeding

Diagnosis

Noninfective, HIV related colitis is easily recognized; this diagnosis may be made once infective pathologies have been excluded and the disease remains refractory to standard therapies for inflammatory bowel disease (Clin Infect Dis 2008;47:133)

Laboratory

Stool culture, CD4+ T cell count

Radiology description

Diffuse proctocolitis, consisting of contact bleeding, superficial ulcerations, exudates or loss of vascular pattern

Prognostic factors

Very low CD4+ T cell count

Case reports

Chronic colitis associated with HIV infection can be related to intraepithelial infiltration of the colon by CD8+ T lymphocytes (Int J STD AIDS 2008;19:524)

Treatment

For HIV related diarrhea, maintain adequate hydration and good nutrition
Antiviral reteroviral therapy ART (HAART) or combination ART
Thalidomide has been tried for refractory HIV (Clin Infect Dis 2008;47:133)

Clinical images

Images hosted on other servers:

HIV associated - various images

Colonic ulceration

Healing colonic ulceration

Gross description

Superficial ulceration and hemorrhage

Microscopic (histologic) description

Histologic changes can be minimal or absent in patients with well-controlled HIV

Esophagus

Mid esophagus commonly effected by HIV
Causes well circumscribed / linear ulcers with irregular margins and overhanging edematous edges
Histologically show granulation tissue with mixed acute and chronic inflammatory infiltrate often with eosinophils

AIDS enteropathy

HIV enteropathy causes villous blunting and atrophy, crypt hypertrophy, increased intraepithelial lymphocytes, variably increased mononuclear cell in lamina propria. Increased mitosis in glandular epithelial cells and increased number of apoptotic enterocytes at the surface

AIDS colonopathy

Colon show similar changes but presence of apoptotic cells in glandular epithelium more prominent (Ann Intern Med 1991;114:366, J Gastroenterol Hepatol 1994;9:291)

Microscopic (histologic) images

Contributed by Nalini Bansal, M.D.