1. Enteric pathogens. Infection with an array of enteric pathogens is common in HIV disease. Chronic or recurrent diarrhea is virtually the norm, and the causes are legion. There appears to be an increased frequency of salmonellosis. Small-bowel biopsy in some patients reveals lesions similar to those found in Whipple's disease, raising the question of whether other bowel flora such as mycobacteria may result in systemic disease.
2. Venereal infection. The high incidence of sexually transmitted diseases in the HIV-infected population is mirrored in the increased frequency of gonococcal and chlamydial infection. There is evidence that gonococcal and chlamydial products may persist in joint fluids in persons with arthritis. Some have suggested that inadequate therapy and other host factors lead to incomplete eradication. It is unclear whether HIV infection is associated with persistence of these agents or their products.
b. Psoriatic. There is an increase in both the frequency and severity of all forms of psoriasis in HIV-infected patients. This includes the vulgaris, pustular, and erythroderma forms. There is also an increase in the extra-dermatologic manifestations of the disease, including arthritis. Interestingly, the extra-dermatologic disease tends to follow patterns more commonly associated with variants of Reiter's syndrome, including an increased incidence of conjunctivitis, urethritis, and enthesopathy. No excess of HLA antigens associated with classic psoriasis has been found in this group; indeed there was an increase in HLA-B27. Thus, the line between psoriatic and reactive arthropathy is indistinct in the HIV-infected population.
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