title: Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy.
abstract: Since the introduction of highly active antiretroviral therapy (HAART), the frequency of opportunistic disorders (ODs) of the gastrointestinal (GI) tract in human immunodeficiency virus (HIV)-infected patients has fallen dramatically. We have found, however, that despite the use of HAART, HIV-infected patients can still present with GI ODs. To evaluate the prevalence of GI ODs in HIV-infected patients on HAART who were undergoing endoscopic evaluation for GI-related symptoms. From January 1996 through February 2002, all HIV-infected patients undergoing GI endoscopy were prospectively identified; mucosal biopsies were obtained in a standardized fashion and histologic specimens were examined by a single GI pathologist. All the patients on HAART presenting with a GI OD are described. Results showed that 294 patients (88% men; mean age, 36.5 +/- 10 years; median CD4 lymphocyte count, 64 cells/microl; range, 1-884; median viral RNA level, 40,357 copies/ml; range, 0-7,721,715) underwent 401 upper and/or lower endoscopies during the study period. The use of HAART increased from 10% in early 1996 to 85% in 2002. Nevertheless we found that 27 patients (9%) presented with a GI OD despite HAART. Forty percent of the patients with a GI OD were noncompliant with HAART. We conclude that GI ODs can occur despite HAART and normal CD4 counts. The prevalence of GI ODs in HIV-infected patients taking HAART is 9%. The reasons for this are multifactorial and likely include noncompliance with medications, viral resistance to the drugs, and decreased drug bioavailability. Although the use of HAART has led to a decreased incidence of GI ODs in AIDS, the gastroenterologist evaluating these patients should not discard the possibility that the GI symptoms in HIV-infected patients taking HAART may be secondary to an OD, even when the CD4 count is normal and the viral load is low.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA. Klaus.Moenkemueller@medizin.uni-magdeburg.de
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Mönkemüller
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: Lazenby
authors.forename: David H
authors.initials: DH
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Loudon
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016099:Endoscopy, Gastrointestinal; D005260:Female; D019053:HIV Enteropathy / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D019562:Viral Load
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