[Decision analysis: diagnostic approach in HIV infection associated chronic diarrhea].
Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era.


OBJECTIVE
To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART.


METHODS
Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea.


RESULTS
In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival.


CONCLUSIONS
In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.
Olmos
Martín Alejandro
MA
Médico de Planta de la División de Gastroenterología, Hospital Fernández, Argentina. molmos@fibertel.com.ar
Losso
Marcelo
M
Ruvinsky
Silvina
S
Velázquez
Alberto
A
Augustovski
Federico
F
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes; D002908:Chronic Disease; D003663:Decision Trees; D003967:Diarrhea / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male