title: Noncommunicable diseases in HIV infection in low- and middle-income countries: gastrointestinal, hepatic, and nutritional aspects.
abstract: The purpose of this review was to outline the interaction between HIV and noncommunicable diseases affecting the gastrointestinal (GI) tract, liver, and nutritional disorders in low- and middle-income countries (LMICs), and to identify research priorities. Noncommunicable GI tract disorders are only moderately influenced by HIV, and peptic ulceration is actually less common. However, the impact of HIV on GI cancers needs further investigation. HIV interacts strongly with environmental enteropathy, exacerbating malabsorption of nutrients and drugs. HIV has 2 major effects on noncommunicable liver disease: drug-induced liver injury and nonalcoholic fatty liver disease (particularly in persons of African genetic descent). The effect of HIV on nutrition was one of the first markers of the epidemic in the 1980s, and HIV continues to have major nutritional consequences. Childhood malnutrition and HIV frequently coexist in some regions, for example, southern Africa, resulting in powerful negative interactions with poorer responses to standard nutritional rehabilitation. HIV and nutritional care need to be better integrated, but many questions on how best to do this remain unanswered. Across the spectrum of GI, hepatic, and nutritional disorders in HIV infection, there is increasing evidence that the microbiome may play an important role in disease pathogenesis, but work in this area, especially in low- and middle-income countries, is in its infancy.
authors.affiliation: *Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom; †Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; ‡Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa; and §Massachusetts General Hospital, Boston, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.forename: Haroon
authors.initials: H
authors.lastname: Saloojee
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Chen
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D003906:Developing Countries; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D064307:Microbiota; D009748:Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
chemical_list: D044966:Anti-Retroviral Agents