AGA technical review: Malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease in patients with human immunodeficiency virus infection

Disorders of the gastrointestinal tract and hepatobiliary system are among the most common complications associated with human immunodeficiency virus (HIV) infection. These disorders not only result in major morbidity but mortality as well. With increasing use of prophylaxis against Pneumocystis carinii pneumonia, the incidence of opportunistic gastrointestinal disorders has increased. ^{[1], [2] and [3]} Significant progress has been made in the last decade in characterizing the spectrum of pathogens involving the gastrointestinal and hepatobiliary systems, determining the pathophysiological mechanisms of these diverse processes, and defining management options. Despite these encouraging advancements, many questions remain unanswered. The purpose of this review is to evaluate and synthesize the published clinical research pertaining to three important HIV-related complications: malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease. A separate review addresses disorders of the esophagus.⁴ Attention here is focused on etiology and pathogenesis, clinical features, diagnostic strategies, and efficacy of current treatment options. Recommendations for managing patients with these complications are provided based on the weight of the clinical evidence.GASTROENTEROLOGY 1996;111:1724-1752