[Digestive involvements in human immunodeficiency virus infection].

Dysphagia or odynophagia occurs in an estimated 21% of patients with human immunodeficiency virus infection. A causal agent can be identified in 60-90% of the cases and generally can be successfully eradicated. Oesophageal candidosis, the predominant disorder, usually responds to nitrate derivatives and amphotericine B after a 10 to 15 day cure. Ulcerations of the oesophagus is the second major cause of dysphagia in these patients and result from cytomegalovirus and herpes simplex infections or unknown causes. Epstein-Barr virus infection has been suggested but is rarely demonstrated in clinical situations. Similar to other localizations in HIV-infected patients, Kaposi sarcoma and non-Hodgkin malignant lymphomas are the predominant tumours in the bowel. Infections are essentially revealed by sometimes very severe diarrhoea. Infective agents include Cryptosporidium parvum, microsporidiosae, cytomegalovirus, adenovirus, Isospora belli, Clostridium difficile, Salmonellae and non-tuberculous mycobacteria among others. When the search for an infective agent is negative, the diarrhoea is usually considered to be the expression of HIV infection itself. The clinical approach to HIV-related diarrhoea can be based on decision making management scheme according to the results of stool cultures or on complete exploration protocols. Whatever the diagnostic procedure, symptomatic treatment is of major importance because of the severe nutritional impact of HIV-related diarrhoea.