Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy
- 7 June 2010
- journal article
- Published by Wiley in HIV Medicine
- Vol. 11 (6), 412-417
- https://doi.org/10.1111/j.1468-1293.2009.00807.x
Abstract
The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995.The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations.A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology.When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy.These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.Keywords
This publication has 20 references indexed in Scilit:
- Upper Gastrointestinal Bleeding in a Patient with HIV InfectionClinical Infectious Diseases, 2009
- Risk Factors of Peptic Ulcer in 4943 InpatientsJournal of Clinical Gastroenterology, 2008
- HIV infection and the gastrointestinal immune systemMucosal Immunology, 2007
- Review: Does HIV Infection Alter the Incidence or Pathology of Helicobacter pylori Infection?AIDS Patient Care and STDs, 2007
- Pathogenesis ofHelicobacter pyloriInfectionClinical Microbiology Reviews, 2006
- Epidemiology of gastro-oesophageal reflux disease: a systematic reviewGut, 2005
- Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteersGut, 2005
- Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus‐associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4 countsJournal of Gastroenterology and Hepatology, 2004
- Highly Active Antiretroviral Therapy and Incidence of Cancer in Human Immunodeficiency Virus-Infected AdultsJNCI Journal of the National Cancer Institute, 2000
- AIDS and the gutJournal of Gastroenterology and Hepatology, 1994