The differential diagnosis of abdominal pain in patients with HIV can be related to opportunistic infections (CMV, MAC) in the setting of severe immunodeficiency, or may be due to other more common etiologies seen in the general population (eg, appendicitis, diverticulitis). The widespread adoption of highly active antiretroviral therapy (HAART) has been associated with a number of drug-induced side effects, including pancreatitis and the lactic acidosis syndrome, both of which are associated with abdominal pain [1,2].
An overview of the diagnosis of abdominal pain in patients with HIV will be presented here. Other gastrointestinal and hepatobiliary complications in these patients are discussed separately. (See "Evaluation of the HIV-infected patient with odynophagia and dysphagia" and "Evaluation of the HIV-infected patient with diarrhea" and "Evaluation of the HIV-infected patient with anorectal symptoms" and "Evaluation of the HIV-infected patient with hepatobiliary complaints".)
The incidence of gastrointestinal complaints, including abdominal pain, is not well established. Severe abdominal pain was observed in approximately 15 percent of HIV-infected patients and was associated with reduced survival in the pre-HAART era .
A few general rules are useful when evaluating gastrointestinal complaints in patients with AIDS:
●Clinical signs and symptoms alone are rarely diagnostic.