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Gastrointestinal Imaging

E3321. HIV Below the Belt: Infections, Tumors, and Everything in Between

Patel C1,  Patel M1,2,  Nguyen M2,  Pahwa A2,  Mohammad S.2 1. University of California, Los Angeles, Los Angeles, CA; 2. Olive View-University of California Los Angeles Medical Center, Sylmar, CA

Address correspondence to S. Mohammad (smohammad@dhs.lacounty.gov)

Background Information: As the number of patients living with HIV continues to increase and the advanced treatment options allow patients to live longer with the virus, it is important for radiologists to be fully aware of the extent of disease that can be seen in the abdomen to help clinicians determine an appropriate diagnosis and initiate proper therapy promptly. The purpose of this exhibit is to review the pathophysiology and clinical presentation of common various opportunistic infections and neoplastic processes that can affect HIV patients and also provide the associated imaging findings radiologists can use to suggest a specific diagnosis.

Educational Goals/Teaching Points: The educational goals of this exhibit is to review the pathophysiology and clinical presentations of HIV-associated infections and neoplasms in the abdomen and pelvis; illustrate the characteristic imaging features of these entities, including treatment related abnormalities; and integrate clinical and radiologic findings to guide appropriate management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: HIV-related infections and neoplasms can have a variety of manifestations and involve multiple organ systems. Treatment response may mimic worsening of an underlying disease. Participants will learn about opportunistic infections that include bacterial (mycobacteria, Clostridium difficile, typhlitis in gram-positive organisms, and Bartonella henselae), fungal ( Candida, histoplasma capsulatum), viral (cytomegalovirus, herpes simplex virus 3), and protozoal infections (Cryptosporidium, pneumocystis jiroveci); AIDS-related neoplasia including Kaposi sarcoma and non-Hodgkin lymphoma; HIV-related organ manifestations; and treatment related infections such as immune reconstitution inflammatory syndrome (IRIS).

Conclusion: In conclusion, because HIV can remain undiagnosed or untreated due to compounding socioeconomic factors, abdominal manifestations of HIV-associated diseases may be a main presenting feature. It is important for the radiologist to be familiar with these diseases to help guide correct diagnosis and prompt treatment.