Colon non tumor
Infectious colitis (specific microorganisms)
HIV / AIDS associated colitis

Author: Nalini Bansal, M.D., D.N.B., PDCC, MNAMS
Editorial Board Member Review: Raul S. Gonzalez, M.D.

Revised: 20 November 2017, last major update July 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: HIV/AIDS colitis
Cite this page: Bansal, N. HIV/AIDS associated colitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonHIV.html. Accessed November 22nd, 2017.
Definition / general
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-10 coding
  • AIDS (related complex) B20
Epidemiology
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

Microsporidial spores

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
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/ Colonopathy
  • 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
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Nalini Bansal, M.D., D.N.B., PDCC, MNAMS

Cryptosporidiosis

Strongyloides

Amoeboma

Herpes



Images hosted on other servers:

Microsporidial spores are seen as intraepithelial inclusions and birefringent using polarized light (ZN stain)

Missing Image

Candida (esophagus)

Missing Image

Candidal pseudohyphae and spores (PASD stain)

Missing Image

CMV infected cells

Missing Image

CMV gastritis


Missing Image

CMV vasculitis

Missing Image

Cryptococcosis (GMS stain)

Missing Image Missing Image

Cryptosporidiosis

Missing Image

Giardiasis

Missing Image

Histoplasmosis (GMS stain)


Missing Image

HIV enteropathy

Missing Image

HSV esophagitis

Missing Image

HSV cytopathic effect

Missing Image Missing Image

Kaposi sarcoma

Missing Image

Mycobacterium avium-intercellulare (acid fast stain)

Molecular / cytogenetics description
  • HIV nucleic acid identified by in situ hybridization in colonic biopsies
  • HIV DNA confirmed by Southern blot analysis
Board review question #1
Most common site of localization and replication of HIV virus?

  1. Brain
  2. Gastrointestinal tract
  3. Liver
  4. Lungs
Board review answer #1
B. Gastrointestinal tract
Board review question #2
Most common opportunistic infection in AIDS colitis?

  1. CMV
  2. Cryptosporidiosis
  3. Giardia
  4. Herpes
Board review answer #2
A. CMV
Board review question #3
Most opportunistic infection occur when CD4+ T cell count is below?

  1. 200/mm3
  2. 400/mm3
  3. 500/mm3
  4. 700/mm3
Board review answer #3
A. 200/mm3