Features of Gastrointestinal Bleeding in Patients with HIV-Related Infections

Gastrointestinal hemorrhage is about 1.3 times more common in HIV-infected patients than in HIV-negative ones. At the same time the structural and etiological causes of hemorrhage in HIV differ in many ways from the main population which is undoubtedly due to the use of modern antiretroviral therapy, opportunistic infections and comorbidities.
Aim: to study the factors which are aggravating the course and influencing the structure of gastrointestinal bleeding in patients with HIV infection on the background of immunosuppressive disorders in comparison with HIV-negative patients.
Material and methods. To achieve this goal a multicenter retrospective cohort study of three groups of patients with gastrointestinal hemorrhage was conducted. Five hundred patients participated in the study: n = 111 — the main group (42 in Group 1 — HIV+, CD4+ > 200; 69 in Group 2 — HIV+, CD4+ < 200); n = 389 — in the control group (Group 3 — HIV-negative status).
Results. It was found that the comparison groups differ in age, the presence of previous hematological pathology (anemia, thrombocytopenia) as well as the sources of gastrointestinal bleeding. It can be noted that in all comparison groups endoscopic hemostasis methods were effective in about half of the cases (50.0 %, 42.0 % and 49.7 %), in the remaining findings hemostatic therapy was effective and sufficient (47.6 %, 33.3 % and 39.7 %). Surgical treatment was much more often required (statistically significant) in the group of patients with low immune status (29.0 %), and the need for it was associated with “rare sources” of bleeding: tuberculous intestinal ulcers, cytomegalovirus intestinal ulcers and decomposing Kaposi’s sarcoma of various parts of the digestive tract. The overall survival rate of HIV-infected patients with low immune status and gastrointestinal bleeding was statistically lower than in HIV-negative patients or patients with satisfactory immune status.
Conclusion. Gastrointestinal bleeding in HIV-positive patients has a number of significant features, that directly affect severity of blood loss, treatment methods and patient survival.

1. Wuerth B.A., Rockey D.C. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: A nationwide analysis. Dig Dis Sci. 2018;63(5):1286–93. DOI: 10.1007/s10620-017-4882-6

2. Darvin V.V., Il'kanich A.Ya., Satinov A.V., Ryzhikov M.G., Oganyan A.V., Bryukhov A.N., et al. Characteristics of the structure of patients with acute bleeding from the upper gastrointestinal tract. Vestnik SurGU. Meditsina. 2021;2(48):22–9. (In Russ.). DOI: 10.34822/2304-9448-2021-2-22-29

3. Podoluzhnyy V.I., Oorzhak O.V., Krasnov K.A. Hospitalization patterns in patients with upper gastrointestinal bleeding. Fundamental and Clinical Medicine. 2018;3(4):39–43. (In Russ.). DOI: 10.23946/2500-0764-2018-3-4-39-43

4. Fouad T.R., Abdelsameea E., Abdel-Razek W., Attia A., Mohamed A., Metwally K., et al. Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post-therapeutic outcome and prognostic indicators. J Gastroenterol Hepatol. 2019;34(9):1604–10. DOI: 10.1111/jgh.14659

5. Long B., Gottlieb M. Emergency medicine updates: Upper gastrointestinal bleeding. Am J Emerg Med. 2024;81:116–23. DOI: 10.1016/j.ajem.2024.04.052

6. Arıkoğlu S., Tezel O., Büyükturan G., Başgöz B.B. The efficacy and comparison of upper gastrointestinal bleeding risk scoring systems on predicting clinical outcomes among emergency unit patients. BMC Gastroenterol. 2025;25(1):93. DOI: 10.1186/s12876-025-03684-7

7. Atri S., Hammami M., Belhadj A., Chebbi F., Chaker Y., Kacem M. A rare case of upper gastrointestinal hemorrhage due to tuberculous lymphadenitis fistulized in the duodenum. Int J Emerg Med. 2025;18(1):84. DOI: 10.1186/s12245-025-00883-7

8. Imran H., Alexander J.T., Jackson C.D. Lower gastrointestinal hemorrhage. JAMA. 2024;331(19):1666–7. DOI: 10.1001/jama.2023.25841

9. Tsybikova E.B., Kotlovskiy M.Yu., Fadeeva S.O., Lorsanov S.M. Dynamics in HIV incidence in Russia and constituent entities of the Russian Federation, 2016-2022. Social'nye aspekty zdorov'a naselenia. 2024;70(1):14. (In Russ.). DOI: 10.21045/2071-5021-2024-70-1-14

10. Bratton E., Vannappagari V., Kobayashi M.G. Prevalence of and risk for gastrointestinal bleeding and peptic ulcerative disorders in a cohort of HIV patients from a U.S. healthcare claims database. PLoS ONE. 2017;12(6):e0180612. DOI: 10.1371/journal.pone.0180612

11. Khasanova G.M., Urunova D.M., Akhmedzhanova Z.I., Giyasova G.M., Chernikova A.A., Khasanova A.N. Defeat of the gastrointestinal tract in HIV infection. Pacific Medical Journal. 2019;3(77):24–8. (In Russ.). DOI: 10.17238/PmJ1609-1175.2019.3.24–28

12. Poluektov V.L., Nazarova O.I., Nikitin V.N., Klipach S.G., Sitnikova M.V. Complicated giant duodenal ulcer in the HIV-infected patient. Grekov’s Bulletin of Surgery. 2019;178(3):58–62. (In Russ.). DOI: 10.24884/0042-4625-2019-178-3-54-58

13. Balasubramaniam M., Pandhare J., Dash C. Immune control of HIV. J Life Sci (Westlake Village). 2019;1(1):4–37. DOI: 10.36069/JoLS/20190603

14. Barkun A.N., Almadi M., Kuipers E.J., Laine L., Sung J., Tse F., et al. Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the International Consensus Group. Ann Intern Med. 2019;171(11):805–22. DOI: 10.7326/M19-1795

15. Clinical recommendations of the Russian Society of Surgeons: Ulcerative gastroduodenal bleeding. (In Russ.). URL: https://www.mrckb.ru/files/yazvennye_gastroduodenalnye_krovotecheniya.PDF

16. Clinical recommendations of the Russian Society of Surgeons: On the treatment of bleeding from varicose veins of the esophagus and stomach. (In Russ.). URL: https://www.mrckb.ru/files/krovotecheniya_iz_varikoznorasshirennyx_ven_pishhevoda_i_zheludka.PDF

17. Emergency medical care. Clinical recommendations. Ed. S.F. Bagnenko. Moscow: GEOTAR-Media, 2022. (In Russ.).

18. Vakil N. Peptic ulcer disease: A review. JAMA. 2024;332(21):1832–42. DOI: 10.1001/jama.2024.19094

19. Cagir Y., Durak M.B., Yuksel I. Optimal endoscopy timing in elderly patients presenting with acute nonvariceal upper gastrointestinal bleeding. BMC Gastroenterol. 2024;24(1):444. DOI: 10.1186/s12876-024-03541-z

20. Durandt C., Potgiete J.C., Mellet J., Herd C., Khoosal R., Nel J.G., et al. HIV and haematopoiesis. S Afr Med J. 2019;109(8b):40–5. DOI: 10.7196/SAMJ.2019.v109i8b.13829

21. Marchionatti A., Parisi M.M. Anemia and thrombocytopenia in people living with HIV/AIDS: A narrative literature review. Int Health. 2021;13(2):98–109. DOI: 10.1093/inthealth/ihaa036

22. Cao G., Wang Y., Wu Y., Jing W., Liu J., Liu M. Prevalence of anemia among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine. 2022;44:101283. DOI: 10.1016/j.eclinm.2022.101283

23. Xie B., Huang W., Hu Y., Dou Y., Xie L., Zhang Y., et al. Anemia and opportunistic infections in hospitalized people living with HIV: A retrospective study. BMC Infect Dis. 2022;22(1):912. DOI: 10.1186/s12879-022-07910-5

24. Fiseha T., Ebrahim H. Prevalence and predictors of cytopenias in HIV-infected adults at initiation of antiretroviral therapy in Mehal Meda Hospital, Central Ethiopia. J Blood Med. 2022;13:201–11. DOI: 10.2147/JBM.S355966

25. Lv X., Li P., Yue P., Tang P., Zhou F.Risk factors and prognosis of thrombocytopenia in people living with HIV/AIDS. Ther Adv Hematol. 2023;14:20406207231170513. DOI: 10.1177/20406207231170513

26. Getawa S., Aynalem M., Bayleyegn B., Adane T. The global prevalence of thrombocytopenia among HIVinfected adults: A systematic review and meta-analysis. Int J Infect Dis. 2021;105:495–504. DOI: 10.1016/j.ijid.2021.02.118

27. Nka A.D., Sosso S.M., Fokam J., Bouba Y., Teto G., Simo Rachel R., et al. Thrombocytopenia according to antiretroviral drug combinations, viremia and CD4 lymphocytes among HIV-infected patients in Cameroon: A snapshot from the City of Yaoundé. BMC Res Notes. 2019;12(1):632. DOI: 10.1186/s13104-019-4664-7

28. Yavuz A., Toksöz Yıldırım A.N., Akan K., Çolak Y., Tuncer İ. Recurrent gastrointestinal bleeding in an HIVpositive patient: A case report. Cureus. 2020;12(9):e10688. DOI: 10.7759/cureus.10688

29. Riedel D.J., Nugent S.L., Gilliam B.L. Upper gastrointestinal bleeding in a patient with HIV infection. Clin Infect Dis. 2009;48(3):321–69. DOI: 10.1086/595849