HIV Pozitif Hastalarda Karın Ağrısı
Özet
İnsan bağışıklık yetmezliği virüsü (HIV) ile yaşayan hastalarda karın ağrısı, geniş ve heterojen bir etiyolojik spektrumdan kaynaklanabilen, tanısal ve yönetimsel açıdan zorluklar içeren önemli bir klinik problemdir. Bu hasta grubunda karın ağrısı; fırsatçı enfeksiyonlar, klasik akut cerrahi nedenler, jinekolojik patolojiler ve santral aracılı kronik ağrı sendromları ile ilişkili olabilir. Özellikle dissemine histoplazmoz gibi edinilmiş bağışıklık yetmezliği sendromu (AIDS) tanımlayıcı enfeksiyonlar, endemik bölgelerde gastrointestinal tutulum ve karın ağrısının başlıca nedenleri arasında yer almaktadır. Akut apandisit ve peritonit gibi cerrahi acillerde, HIV pozitif hastalarda da klasik klinik ve görüntüleme algoritmalarının geçerliliğini koruduğu görülmektedir. Öte yandan, organik nedenler dışlandıktan sonra santral aracılı karın ağrısı sendromları kronik ağrının önemli nedenleri olarak öne çıkmaktadır. Bu bölüm, HIV pozitif hastada karın ağrısına yaklaşımda klinik değerlendirme, laboratuvar ve görüntüleme yöntemlerini bütüncül bir çerçevede ele almakta; enfeksiyon hastalıkları, cerrahi, gastroenteroloji ve psikiyatri disiplinlerinin entegrasyonunun önemini vurgulamaktadır.
Abdominal pain in people living with HIV represents a complex clinical challenge due to its broad and heterogeneous etiological spectrum. In this population, abdominal pain may arise from opportunistic gastrointestinal infections, classical acute surgical conditions, gynecologic pathologies, or centrally mediated chronic pain syndromes. Opportunistic infections, particularly AIDS defining conditions such as disseminated histoplasmosis, remain a major cause of gastrointestinal involvement and abdominal pain, especially in endemic regions. Acute surgical, conditions including appendicitis and peritonitis, should be evaluated using standard clinical and imaging algorithms, which remain applicable in HIV positive patients. Additionally, after exclusion of organic and infectious causes, disorders of gut-brain interaction and centrally mediated abdominal pain syndrome emerge as important contributors to chronic abdominal pain. This chapter provides a synthesized, evidence-based overview of the differential diagnosis, clinical evaluation, and management of abdominal pain in HIV positive patients, emphasizing the need for an integrated, multidisciplinary approach involving infectious diseases, surgery, gastroenterology, and psychiatry.
Referanslar
Nacher M, Valdes A, Adenis A, et al. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Neglected Tropical Diseases. 2021;15(1):e0009050. doi:10.1371/journal.pntd.0009050
Gubska OYu. Chronic abdominal pain: A multidisciplinary approach in gastroenterology and psychiatry. Gastroenterology. 2024;58(4):295–300. doi:10.22141/2308-2097.58.4.2024.642
Bruce RD, Merlin J, Lum PJ, et al. HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV. Clinical Infectious Diseases. 2017;65(10):e1–e37. doi:10.1093/cid/cix636
Colucciello S. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy. Emergency Medicine Practice. 2019;21(6):1–32.
Kosmidis C, Anthimidis G, Vasiliadou K. Acute abdomen and HIV infection. In: HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications. Rijeka: InTech; 2011. doi:10.5772/23981
Yoshida D, Caruso JM. Abdominal pain in the HIV infected patient. Journal of Emergency Medicine. 2002;23(2):111–116. doi:10.1016/S0736-4679(02)00498-5
Abdominal pain in HIV infection. QJM: An International Journal of Medicine. 1991. doi:10.1093/oxfordjournals.qjmed.a068547
Merlin JS, Cen L, Praestgaard A, et al. Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. Journal of Pain and Symptom Management. 2012;43(3):638–645. doi:10.1016/j.jpainsymman.2011.04.019
Surratt HL, Kurtz SP, Levi-Minzi MA, et al. Pain treatment and antiretroviral medication adherence among vulnerable HIV-positive patients. AIDS Patient Care and STDs. 2015;29(4):186–192. doi:10.1089/apc.2014.0104
Nkhoma K, Norton C, Sabin C, et al. Self-management interventions for pain and physical symptoms among people living with HIV: A systematic review. Journal of Acquired Immune Deficiency Syndromes. 2018;79(2):206–225. doi:10.1097/QAI.0000000000001785
Aires EM, Bammann RH. Pain in hospitalized HIV-positive patients: clinical and therapeutical issues. Brazilian Journal of Infectious Diseases. 2005;9(3). doi:10.1590/S1413-86702005000300002
Slaven EM, Lopez F, Weintraub SL, et al. The AIDS patient with abdominal pain: a new challenge for the emergency physician. Emergency Medicine Clinics of North America. 2003;21(4):987–1015. doi:10.1016/S0733-8627(03)00070-1
Dzwonkowski M, Iqbal U, Shah N, et al. Disseminated cryptococcosis masquerading as large abdominal mass concerning for pancreatic malignancy in an HIV-positive patient. American Journal of Gastroenterology. 2022;117(Suppl):e1832–e1833. doi:10.14309/01.ajg.0000867836.55884.02
Cosme A, Pardo E, Felipo F, et al. Abdominal pain in a HIV-infected patient. Revista Española de Enfermedades Digestivas. 2005;97(3). doi:10.4321/S1130-01082005000300008
Faller AP, Kurnosov AV. Features of the clinical picture of acute peritonitis in HIV-infected patients. Bulletin of the Medical Institute of Continuing Education. 2024;4(3):92–100. doi:10.36107/2782-1714_2024-4-3-92-100
Pereira MG, Martínez Antolinos C, Canosa Fernandez A, et al. Intestinal spirochetosis in an HIV-positive patient. European Journal of Case Reports in Internal Medicine. 2021;8(7). doi:10.12890/2021_002686
Laäs R, Clarke DL, Dufourq N, et al. The influence of HIV status on acute appendicitis: a retrospective study from South Africa. World Journal of Surgery. 2023;47(11):2608–2616. doi:10.1007/s00268-023-07103-4
Ackerman M, Frost A, Stanford K. Abdominal pain and fever in a patient with human immunodeficiency virus: a case report. International Journal of Emergency Medicine. 2022;15(1):35. doi:10.1186/s12245-022-00439-z
Magno P, De Jesus-Aponte R, Vazquez GJ, et al. Abdominal pain and weight loss in an HIV-infected patient. Journal of Digestive Diseases. 2008;9(1):48–51. doi:10.1111/j.1443-9573.2007.00317.x
Venkataramani A, Behling CA, Lyche KD. Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient. American Journal of Gastroenterology. 1997;92(6):1059–1060.
Gopalakrishnan R, Balaguru P, Sridharan S. Current opinion on the management of diarrhea in the HIV infected individual. Current Opinion in Infectious Diseases. 2025;38(5):433–441. doi:10.1097/QCO.0000000000001141
Zhu XL, Lv SX, Wen L, et al. Clinical and CT features of HIV-negative and HIV-positive patients with abdominal tuberculous lymphadenopathy. Diagnostics. 2025;15(22):2931. doi:10.3390/diagnostics15222931
Ekeng BE, Itam-Eyo AE, Osaigbovo II, et al. Gastrointestinal histoplasmosis: a descriptive review, 2001–2021. Life. 2023;13(3):689. doi:10.3390/life13030689
Nacher M, Valdes A, Adenis A, et al. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Neglected Tropical Diseases. 2021;15(1):e0009050. doi:10.1371/journal.pntd.0009050
Bedada AG, Hsiao M, Azzie G. HIV infection: its impact on patients with appendicitis in Botswana. World Journal of Surgery. 2019;43(9):2131–2136. doi:10.1007/s00268-019-05040-9
Hassan A, Denise-Espina T, Woc WS. Abdominal pain in newly diagnosed HIV patient: more serious than you think. American Journal of Gastroenterology. 2015;110(Suppl):S433–S434. doi:10.14309/00000434-201510001-01003
Azagew AW, Woreta HK, Tilahun AD, et al. High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia. Journal of Pain Research. 2017;10:2461–2469. doi:10.2147/JPR.S141189
Martinez YA, Segarra C, Pagan A, et al. Disseminated Mycobacterium avium complex ileitis, duodenitis, and pancolitis in an immunocompromised patient with HIV/AIDS. American Journal of Gastroenterology. 2020;115(Suppl):S913–S914. doi:10.14309/01.ajg.0000709116.44208.3f
Musa A, Gboluaje T, Asemota J, et al. Disseminated Mycobacterium avium complex infection in an HIV patient with small bowel and liver involvement. American Journal of Gastroenterology. 2021;116(Suppl):S1260–S1261. doi:10.14309/01.ajg.0000785740.16791.de
Zhang W, Yu H, Luo N, et al. Clinical characteristics and treatment outcomes in HIV-infected patients with liver abscess. Medical Science Monitor. 2020;26:e923761. doi:10.12659/MSM.923761
Ilustrisimo T, Serrano A, Salvo R, et al. AIDS cholangiopathy presenting with ongoing CMV colitis and cryptosporidium-related diarrhea. American Journal of Gastroenterology. 2021;116(Suppl):S745–S746. doi:10.14309/01.ajg.0000780200.62223.49
Potter DA, Danforth DN, Macher AM, et al. Evaluation of abdominal pain in the AIDS patient. Annals of Surgery. 1984;199(3):332–339. doi:10.1097/00000658-198403000-00014
Nkhoma K, Norton C, Sabin C, et al. Self-management interventions for pain and physical symptoms among people living with HIV: A systematic review. Journal of Acquired Immune Deficiency Syndromes. 2018;79(2):206–225. doi:10.1097/QAI.0000000000001785
Chen YO, Safren SA. Non-pharmacological interventions addressing chronic pain in people living with HIV. Current HIV/AIDS Reports. 2025;22(1):24. doi:10.1007/s11904-025-00734-3
Krashin DL, Merrill JO, Trescot AM. Opioids in the management of HIV-related pain. Pain Physician. 2012;15(3 Suppl):ES157–ES168.
Referanslar
Nacher M, Valdes A, Adenis A, et al. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Neglected Tropical Diseases. 2021;15(1):e0009050. doi:10.1371/journal.pntd.0009050
Gubska OYu. Chronic abdominal pain: A multidisciplinary approach in gastroenterology and psychiatry. Gastroenterology. 2024;58(4):295–300. doi:10.22141/2308-2097.58.4.2024.642
Bruce RD, Merlin J, Lum PJ, et al. HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV. Clinical Infectious Diseases. 2017;65(10):e1–e37. doi:10.1093/cid/cix636
Colucciello S. Assessing abdominal pain in adults: a rational, cost-effective, and evidence-based strategy. Emergency Medicine Practice. 2019;21(6):1–32.
Kosmidis C, Anthimidis G, Vasiliadou K. Acute abdomen and HIV infection. In: HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications. Rijeka: InTech; 2011. doi:10.5772/23981
Yoshida D, Caruso JM. Abdominal pain in the HIV infected patient. Journal of Emergency Medicine. 2002;23(2):111–116. doi:10.1016/S0736-4679(02)00498-5
Abdominal pain in HIV infection. QJM: An International Journal of Medicine. 1991. doi:10.1093/oxfordjournals.qjmed.a068547
Merlin JS, Cen L, Praestgaard A, et al. Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. Journal of Pain and Symptom Management. 2012;43(3):638–645. doi:10.1016/j.jpainsymman.2011.04.019
Surratt HL, Kurtz SP, Levi-Minzi MA, et al. Pain treatment and antiretroviral medication adherence among vulnerable HIV-positive patients. AIDS Patient Care and STDs. 2015;29(4):186–192. doi:10.1089/apc.2014.0104
Nkhoma K, Norton C, Sabin C, et al. Self-management interventions for pain and physical symptoms among people living with HIV: A systematic review. Journal of Acquired Immune Deficiency Syndromes. 2018;79(2):206–225. doi:10.1097/QAI.0000000000001785
Aires EM, Bammann RH. Pain in hospitalized HIV-positive patients: clinical and therapeutical issues. Brazilian Journal of Infectious Diseases. 2005;9(3). doi:10.1590/S1413-86702005000300002
Slaven EM, Lopez F, Weintraub SL, et al. The AIDS patient with abdominal pain: a new challenge for the emergency physician. Emergency Medicine Clinics of North America. 2003;21(4):987–1015. doi:10.1016/S0733-8627(03)00070-1
Dzwonkowski M, Iqbal U, Shah N, et al. Disseminated cryptococcosis masquerading as large abdominal mass concerning for pancreatic malignancy in an HIV-positive patient. American Journal of Gastroenterology. 2022;117(Suppl):e1832–e1833. doi:10.14309/01.ajg.0000867836.55884.02
Cosme A, Pardo E, Felipo F, et al. Abdominal pain in a HIV-infected patient. Revista Española de Enfermedades Digestivas. 2005;97(3). doi:10.4321/S1130-01082005000300008
Faller AP, Kurnosov AV. Features of the clinical picture of acute peritonitis in HIV-infected patients. Bulletin of the Medical Institute of Continuing Education. 2024;4(3):92–100. doi:10.36107/2782-1714_2024-4-3-92-100
Pereira MG, Martínez Antolinos C, Canosa Fernandez A, et al. Intestinal spirochetosis in an HIV-positive patient. European Journal of Case Reports in Internal Medicine. 2021;8(7). doi:10.12890/2021_002686
Laäs R, Clarke DL, Dufourq N, et al. The influence of HIV status on acute appendicitis: a retrospective study from South Africa. World Journal of Surgery. 2023;47(11):2608–2616. doi:10.1007/s00268-023-07103-4
Ackerman M, Frost A, Stanford K. Abdominal pain and fever in a patient with human immunodeficiency virus: a case report. International Journal of Emergency Medicine. 2022;15(1):35. doi:10.1186/s12245-022-00439-z
Magno P, De Jesus-Aponte R, Vazquez GJ, et al. Abdominal pain and weight loss in an HIV-infected patient. Journal of Digestive Diseases. 2008;9(1):48–51. doi:10.1111/j.1443-9573.2007.00317.x
Venkataramani A, Behling CA, Lyche KD. Sclerosing mesenteritis: an unusual cause of abdominal pain in an HIV-positive patient. American Journal of Gastroenterology. 1997;92(6):1059–1060.
Gopalakrishnan R, Balaguru P, Sridharan S. Current opinion on the management of diarrhea in the HIV infected individual. Current Opinion in Infectious Diseases. 2025;38(5):433–441. doi:10.1097/QCO.0000000000001141
Zhu XL, Lv SX, Wen L, et al. Clinical and CT features of HIV-negative and HIV-positive patients with abdominal tuberculous lymphadenopathy. Diagnostics. 2025;15(22):2931. doi:10.3390/diagnostics15222931
Ekeng BE, Itam-Eyo AE, Osaigbovo II, et al. Gastrointestinal histoplasmosis: a descriptive review, 2001–2021. Life. 2023;13(3):689. doi:10.3390/life13030689
Nacher M, Valdes A, Adenis A, et al. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Neglected Tropical Diseases. 2021;15(1):e0009050. doi:10.1371/journal.pntd.0009050
Bedada AG, Hsiao M, Azzie G. HIV infection: its impact on patients with appendicitis in Botswana. World Journal of Surgery. 2019;43(9):2131–2136. doi:10.1007/s00268-019-05040-9
Hassan A, Denise-Espina T, Woc WS. Abdominal pain in newly diagnosed HIV patient: more serious than you think. American Journal of Gastroenterology. 2015;110(Suppl):S433–S434. doi:10.14309/00000434-201510001-01003
Azagew AW, Woreta HK, Tilahun AD, et al. High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia. Journal of Pain Research. 2017;10:2461–2469. doi:10.2147/JPR.S141189
Martinez YA, Segarra C, Pagan A, et al. Disseminated Mycobacterium avium complex ileitis, duodenitis, and pancolitis in an immunocompromised patient with HIV/AIDS. American Journal of Gastroenterology. 2020;115(Suppl):S913–S914. doi:10.14309/01.ajg.0000709116.44208.3f
Musa A, Gboluaje T, Asemota J, et al. Disseminated Mycobacterium avium complex infection in an HIV patient with small bowel and liver involvement. American Journal of Gastroenterology. 2021;116(Suppl):S1260–S1261. doi:10.14309/01.ajg.0000785740.16791.de
Zhang W, Yu H, Luo N, et al. Clinical characteristics and treatment outcomes in HIV-infected patients with liver abscess. Medical Science Monitor. 2020;26:e923761. doi:10.12659/MSM.923761
Ilustrisimo T, Serrano A, Salvo R, et al. AIDS cholangiopathy presenting with ongoing CMV colitis and cryptosporidium-related diarrhea. American Journal of Gastroenterology. 2021;116(Suppl):S745–S746. doi:10.14309/01.ajg.0000780200.62223.49
Potter DA, Danforth DN, Macher AM, et al. Evaluation of abdominal pain in the AIDS patient. Annals of Surgery. 1984;199(3):332–339. doi:10.1097/00000658-198403000-00014
Nkhoma K, Norton C, Sabin C, et al. Self-management interventions for pain and physical symptoms among people living with HIV: A systematic review. Journal of Acquired Immune Deficiency Syndromes. 2018;79(2):206–225. doi:10.1097/QAI.0000000000001785
Chen YO, Safren SA. Non-pharmacological interventions addressing chronic pain in people living with HIV. Current HIV/AIDS Reports. 2025;22(1):24. doi:10.1007/s11904-025-00734-3
Krashin DL, Merrill JO, Trescot AM. Opioids in the management of HIV-related pain. Pain Physician. 2012;15(3 Suppl):ES157–ES168.
