Etiology and Pharmacologic Management of Noninfectious Diarrhea in HIV-Infected Individuals in the Highly Active Antiretroviral Therapy Era
Etiology and Pharmacologic Management of Noninfectious Diarrhea in HIV-Infected Individuals in the Highly Active Antiretroviral Therapy Era
复制标题
DOI：
10.1093/cid/cis544
复制
发表时间：
2012-09-15
影响因子：
11.8
通讯作者：
DuPont, Herbert L.
中科院分区：
文献类型：
--
作者：
MacArthur, Rodger D.;DuPont, Herbert L.
尽管采用高效的抗逆转录病毒疗法 (HAART)，腹泻仍然是人类免疫缺陷病毒 (HIV) 感染患者的常见问题，并且可能对患者的生活质量产生负面影响，并导致终止或更换 HAART 治疗方案。在HAART时代，机会性感染引起的腹泻并不常见，而HIV相关腹泻往往有非感染性原因，包括HAART相关不良事件和HIV肠病。与HAART相关的腹泻通常是由蛋白酶抑制剂（例如利托那韦）引起的，它可能会损害肠上皮屏障（渗漏性腹泻）和/或改变氯离子分泌（分泌性腹泻）。 HIV肠病可能是由HIV对胃肠道细胞、胃肠道免疫系统和肠道相关淋巴组织的直接影响引起的，这些可能是HIV感染和持续炎症和粘膜损伤的活跃部位。需要针对非感染性腹泻致病机制的新疗法。
Diarrhea remains a common problem for patients with human immunodeficiency virus (HIV) infection despite highly active antiretroviral therapies (HAART) and can negatively affect patient quality of life and lead to discontinuation or switching of HAART regimens. In the era of HAART, diarrhea from opportunistic infections is uncommon, and HIV-associated diarrhea often has noninfectious causes, including HAART-related adverse events and HIV enteropathy. Diarrhea associated with HAART is typically caused by protease inhibitors (eg, ritonavir), which may damage the intestinal epithelial barrier (leaky-flux diarrhea) and/or alter chloride ion secretion (secretory diarrhea). HIV enteropathy may result from direct effects of HIV on gastrointestinal tract cells and on the gastrointestinal immune system and gut-associated lymphoid tissue, which may be active sites of HIV infection and ongoing inflammation and mucosal damage. New therapies targeting the pathogenic mechanisms of noninfectious diarrheas are needed.