Clinical Gastroenterology Series Editor: George Y. Wu Lisa M. Chirch Jurate Ivanaviciene E ditors HIV and GI Tract Complications A Comprehensive Clinical Guide Clinical Gastroenterology Series Editor: George Y. Wu Division of Gastroenterology-Hepatology University of Connecticut School of Medicine Farmington, CT, USA More information about this series at http://www.springer.com/series/7672 Lisa M. Chirch • Jurate Ivanaviciene Editors HIV and GI Tract Complications A Comprehensive Clinical Guide Editors Lisa M. Chirch Jurate Ivanaviciene Division of Infectious Diseases Division of Infectious Diseases University of Connecticut St. Vincent’s Medical Center School of Medicine Bridgeport, CT Farmington, CT USA USA ISSN 2197-7399 ISSN 2197-7704 (electronic) Clinical Gastroenterology ISBN 978-3-030-13376-4 ISBN 978-3-030-13377-1 (eBook) https://doi.org/10.1007/978-3-030-13377-1 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Humana Press imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface The last three decades have witnessed dramatic strides in our ability to successfully treat and manage infection with the human immunodeficiency virus (HIV). The ongoing development and availability of more effective and better-tolerated antiret- roviral (ARV) medications have contributed to this, resulting in virologic suppres- sion in a majority of patients taking ARVs. The rollout of certain ARVs for pre-exposure prophylaxis or “PrEP” represents an example of successful innovation to reduce the number of new infections. However, we continue to see new increas- ing numbers of new infections, particularly in certain patient populations, such as young men who have sex with men (MSM) and those of Hispanic or African descent. Coinfection with other viruses, such as hepatitis C virus (HCV), addressed later in this book, represents a significant ongoing challenge, especially as it relates to the opioid epidemic. End organ damage, such as liver cirrhosis and failure in this case, but also cardiovascular and renal disease, and malignancy, may now present more of an existential threat to individuals living with HIV, even those with well- controlled infection. To this end, this book will explore the entire gastrointestinal tract and describe its relationship with HIV, detailing the myriad potential manifes- tations related to opportunistic infections, medications, and HIV-related malig- nancy, among others. Chapters are organized by organ system within the GI tract, with liver diseases covered in two separate chapters, one focusing on viral hepatitis. It is our hope that the information summarized in this work will help guide clini- cians who care for this patient population in their continued efforts to improve qual- ity and extend survival in those living with HIV infection. Farmington, CT, USA Lisa M. Chirch, MD, FIDSA v Contents 1 Disorders of the Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Alexander Perelman and Houman Rezaizadeh 2 HIV and the Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Sidney Olefson and Haleh Vaziri 3 Biliary Tree and Gallbladder Pathology in HIV . . . . . . . . . . . . . . . . . 25 Sarah Banks and Kavita Prabhakar 4 Disorders of the Liver Excluding Hepatitis A, B, C, D, and E . . . . . . 37 Nishaal Antony, James H. Lewis, and Gayle P. Balba 5 Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Rahul Mahapatra and Jack Fuhrer 6 Disorders of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Mary Snayd and Ulysses Wu 7 Disorders of the Small Bowel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Ann Palmer and Henry Anyimadu 8 Disorders of the Colon and Rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Isaiah P. Schuster and Ramona Rajapakse Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 vii Contributors Nishaal Antony, MD Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA Henry Anyimadu, MD, FACP, FIDSA, AAHIVS Division of Infectious Diseases, The Hospital of Central Connecticut, New Britain, CT, USA Gayle P. Balba, MD Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA Sarah Banks, MD Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT, USA Jack  Fuhrer, MD Division of Infectious Diseases, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA James H. Lewis, MD, FACP, FACG Division of Gastroenterology, Georgetown University Medical Center, Washington, DC, USA Rahul Mahapatra, DO SUNY Upstate Medical University, Syracuse, NY, USA Sidney  Olefson, MD, MBA Division of Gastroenterology & Hepatology, University of Connecticut School of Medicine, Farmington, CT, USA Ann Palmer, MD Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT, USA Alexander Perelman Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT, USA Kavita Prabhakar, MD Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT, USA Ramona Rajapakse, MD, FRCP Division of Gastroenterology and Hepatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA Houman Rezaizadeh Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT, USA ix x Contributors Isaiah P. Schuster, MD Division of Gastroenterology and Hepatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA Mary Snayd Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT, USA Haleh Vaziri, MD Division of Gastroenterology & Hepatology, University of Connecticut School of Medicine, Farmington, CT, USA Ulysses Wu Division of Infectious Diseases, Saint Francis Hospital and Medical Center, Hartford, CT, USA Chapter 1 Disorders of the Esophagus Alexander Perelman and Houman Rezaizadeh Chapter content: In this chapter we will focus on the esophageal manifestations of HIV infection. We will review clinical features of common OIs and noninfectious complications of HIV, as well as diagnostic and therapeutic approaches for clinicians. Clinical Presentation The clinical presentation of esophageal disease is frequently nonspecific, thus mak- ing it difficult to decipher common esophageal disorders such as gastroesophageal reflux and esophageal dysmotility from HIV-associated complications. In patients who are adherent to their ART regimens, viremia is often undetectable, and upper GI symptoms tend to be unrelated to their HIV-positive status [11]. Symptoms most commonly associated with the use of ART relating to the GI tract include nausea, vomiting, diminished appetite, and weight loss. Pancreatitis had previously been reported but is less common with newer regimens. Patients commonly present with complaints of dysphagia, odynophagia, and retrosternal pain. Typically, there is no clear association between symptoms and the underlying pathology. Although a prior study found an association with odynopha- gia and esophageal ulceration, the underlying cause of the ulcer was difficult to identify [12]. A. Perelman (*) · H. Rezaizadeh Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 1 L. M. Chirch, J. Ivanaviciene (eds.), HIV and GI Tract Complications, Clinical Gastroenterology, https://doi.org/10.1007/978-3-030-13377-1_1