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

Author: Lili Lee, M.D. (see Authors page)

Revised: 4 January 2017, last major update December 2013

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

PubMed Search: HIV/AIDS colitis
Cite this page: HIV/AIDS associated colitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonHIV.html. Accessed January 22nd, 2017.
Definition / General
  • Colorectal HIV associated disease is most often associated with secondary infection or neoplasms, but may also present as primary AIDS related enterocolitis
Epidemiology
  • Secondary infection is most often associated with CMV, HSV, Clostridium difficile, Salmonella, Shigella
  • Also Campylobacter, Cryptococcus neoformans, Histoplasma capsulatum, Spirochetosis
  • Also Kaposi sarcoma and nonHodgkin lymphoma
  • Some cases have no other definitive diagnosis and may be due to HIV virus itself (HIV enteropathy)
  • Bacterial infection with Mycobacterium avium-intracellulare often manifests in stomach or small bowel, as do protozoan infections such as Cryptosporidia, Giardia lamblia, Isospora belli, and fungal infections with Microsporidia
  • Adenovirus and the above infectious causes are often overlooked on biopsies of patients with negative stool studies or no response to therapy (Arch Pathol Lab Med 2001;125:1042)
Sites
  • HIV associated disease may be seen anywhere in GI tract
Pathophysiology
  • An imbalance of lymphocyte subpopulations resulting in CD8+ T cell infiltration in colonic mucosa may be associated with chronic colitis in AIDS patients (Int J STD AIDS 2008;19:524)
Clinical Features
  • Diarrhea, weight loss, abdominal pain, GI bleeding
Laboratory
  • Bacterial infections are best identified by stool culture
Case Reports
Treatment
  • Widespread use of antiretroviral therapy has decreased frequency and severity of HIV related illnesses
  • Thalidamide may be effective for refractory HIV associated colitis (Clin Infect Dis 2008;47:133)
Clinical Images

Images hosted on other servers:

HIV associated - various images

Colonic ulceration

Healing colonic ulceration

Gross Description
  • Mucosal ulcerations, vesicles
Micro Description
  • Diffuse and nodular lymphoid hyperplasia with germinal centers
  • Multinucleated giant cells and mononuclear cells within lamina propria (Mod Pathol 1999;12:75)
  • Apoptosis deep in colonic crypts may resemble Grade 1 graft vs. host disease (GVHD)
Micro Images

Images hosted on other servers:
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Candida (esophagus)

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Candidal pseudohyphae and spores (PASD stain)

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CMV infected cells

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CMV gastritis

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CMV vasculitis


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Cryptococcosis (GMS stain)

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Cryptosporidiosis

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Giardiasis

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Histoplasmosis (GMS stain)


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HIV enteropathy

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HSV esophagitis

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HSV cytopathic effect

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Kaposi sarcoma

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Mycobacterium avium-intercellulare (acid fast stain)