Gastrointestinal Emergencies in the Patient with Aids

Durable survival after chemotherapy in a HIV patient with Burkitt's lymphoma presenting with massive upper gastrointestinal bleeding

Massive upper gastrointestinal bleeding is an uncommon presentation of Burkitt's lymphoma in a patient with HIV/AIDS, and is seldom reported in the literature. A 39-year-old man who has sex with men presented with abdominal pain and massive haematemesis and a rapid drop in haemoglobin level to 4.8 g/dL. Upper gastrointestinal endoscopy showed a large blood clot in the stomach, and an emergency laparotomy was performed because of unstable haemodynamics. This showed active bleeding from multiple tumours in the fundus and body of the stomach. The patient underwent gastrectomy and gastric biopsy confirmed Burkitt's lymphoma. Further tests showed lymphoma involvement in bone marrow and central nervous system. The patient tested positive for HIV, and had a CD4 count of 212 cells/mm(3) and viral load of 18,000 copies/mL at diagnosis. He was commenced on a chemotherapy regimen of CODOX-M/IVAC, and highly active antiretroviral therapy consisting of indinavir, stavudine and lamivudine. The major side effect was peripheral neuropathy. Infective complications during chemotherapy were controlled by broad-spectrum antibiotics and anti-fungal agents. Complete remission of the lymphoma was achieved after the chemotherapy and remission was maintained for more than 14 years.

Upper gastrointestinal bleeding in a patient with AIDS

BACKGROUND

A 38-year-old man with AIDS and hepatitis C was admitted to our hospital in January 2005, with complaints of epigastric pain, odynophagia, and melena of 4 days' duration. The patient was not taking highly active antiretroviral therapy because of poor compliance and he denied use of NSAIDs.

INVESTIGATIONS

Physical examination, stool guaiac test, laboratory investigations, and esophagogastroduodenoscopy with biopsies of gastric ulcerations.

DIAGNOSIS

Non-Hodgkin's lymphoma of the stomach (diffuse large B-cell type) with associated gastric ulceration and bleeding.

MANAGEMENT

Injection of epinephrine and bipolar coagulation for the bleeding malignant ulcer, and PPI therapy.

Malnutrition associated with HIV/AIDS. Part Two: Assessment and interventions

Nutritional deficits can be forestalled through early assessment and intervention. Appropriate treatment may alter the continuum of deterioration and improve a patient's quality of life. This article reviews the comprehensive nutritional assessment, the adoption of screening tools, and the multidisciplinary, multimodality treatment approach to malnutrition in HIV/AIDS patients. Examples of creative and practical nutrition programs in HIV/AIDS care are presented because nurses often are in the position to act as change agents and develop clinical programs. The recognition and appreciation of the biopsychosocial consequences of malnutrition is at the crux of the matter for health care professionals. It is the step that propels us to embrace and value nursing interventions to support our patients 'nutritional status. Informing, coaching, teaching, reinforcing behaviors, strengthening social support, and modeling all are key activities of the nursing role that involves other professionals. Nutritional care should be approached as a continuous intervention to be addressed across all care settings and stages of health/illness. It is an inherent piece of all disease state management and wellness programs.

Diarrheal diseases associated with HIV infection

Diarrhea is a major complication of HIV infection and adversely impacts health care costs, quality of life, and even survival of patients. There is a wide variety of potential causes of diarrhea in HIV-infected patients, and the number of pathogens found continues to increase with time. In addition, there is some controversy concerning the role of some organisms in the pathogenesis of diarrhea and the appropriate diagnostic evaluation of affected patients. This article reviews our current understanding of these pathogens and some of the diagnostic and therapeutic approaches for diarrhea associated with HIV infection.