What gastrointestinal problems are common in children with HIV infection?

  • Oral candidiasis (moniliasis or thrush): This may be severe, persistent or recurrent. Oral candidiasis after 2 months of age is uncommon in children who are not HIV-infected.
  • Oesphageal candidiasis: Infants who have severe oral candidiasis and have difficulty swallowing and drool probably have oesophageal candidiasis as well. This serious complication rapidly results in dehydration.
  • Herpes stomatitis: This is often severe in children with HIV infection, resulting in dehydration. Aphthous ulcers and gum infections are also common. Severe herpes stomatitis should be treated with acyclovir.
  • Acute diarrhoea: This is usually due to bacteria and viruses which also cause diarrhoea in children who are not infected with HIV.
  • Chronic diarrhoea: This may complicate acute diarrhoea or be due to opportunistic infections such as Cryptosporidium.
  • Lactose intolerance: This may complicate chronic diarrhoea.

Except for children with mild, acute diarrhoea, all these children should be referred to hospital for further investigation and management. Oral candidiasis can usually be treated with local mycostatin or miconazole at a primary care clinic.

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