Dyspepsia in HIV-infected patients under highly active antiretroviral therapy.
OBJECTIVE
Upper gastrointestinal symptoms, mainly dyspepsia, are common adverse effects in patients under highly active antiretroviral therapy (HAART). Whether it is worthwhile to perform endoscopy early in their treatment is a matter of debate. We have done a prospective study of the prevalence and the etiology of endoscopic lesions in a large cohort of dyspeptic adult HIV-infected patients under HAART, according to their immunological status.


METHODS
528 (334 men and 194 women, mean age 38) HIV-infected patients under HAART with epigastric pain and/or nausea and vomiting underwent upper endoscopy. Patients were classified in two groups, according to CD4 cells counting (>200 cells/mm(3) or < or =200 cells/mm(3)). Gastric and duodenal biopsies were taken from normal mucosa and any lesion found.


RESULTS
Gastric mucosa alterations were seen in 61.74% of patients (40.71% erythema, 18.38% erosion and 2.65% ulcer). Duodenum mucosa alterations were seen in 25.37% of patients, mainly erosions (19.50%) and ulcer (3.59%). There was no difference in endoscopic findings according to CD4 cell count groups. Chronic active gastritis was shown in 459 patients (86.93%). H. pylori infection was seen in 32.38%, and it was more prevalent in the group with CD4 > 200 (p < 0.01). Opportunistic infections and malignancies were seen exclusively in patients with CD4 < or = 200.


CONCLUSIONS
Most of the endoscopic lesions in dyspeptic HIV-infected patients under HAART were not related to AIDS. Upper endoscopy was more helpful in dictating clinical treatment in patients with low CD4 counts (< or =200) and should be done earlier in this group.
Werneck-Silva
Ana Luiza
AL
Casa da AIDS-Infectious Disease Division, School of Medicine, University of São Paulo, Brazil. alwerneck@uol.com.br
Prado
Ivete Bedin
IB
D015746:Abdominal Pain / Q000139:chemically induced / Q000473:pathology; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004384:Duodenoscopy; D004386:Duodenum / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D004415:Dyspepsia / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D009325:Nausea / Q000139:chemically induced / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013270:Stomach / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000473:pathology
D019380:Anti-HIV Agents