What conditions can result in an acute abdomen in HIV infected patients?
Patients with HIV can have any of the usual causes of an acute abdomen; all non–HIV-specific diagnoses must be considered. Perforation is most often due to cytomegalovirus (CMV) infection in the distal small bowel or colon; this is the most common cause of the acute abdomen in late-stage HIV infection.
CMV infection of the vascular endothelial cells leads to mucosal ischemic ulceration and perforation. HIV-associated lymphoma and Kaposi sarcoma also can lead to perforation, but this finding is rare.
Acquired immune deficiency syndrome cholangiopathy, papillitis, and drug-induced pancreatitis (e.g., pentamidine, sulfamethoxazole-trimethoprim [Bactrim], didanosine, ritonavir) are unique causes of abdominal pain in HIV-infected patients.