title: Dyspepsia in HIV-infected patients under highly active antiretroviral therapy.
abstract: 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.
authors.affiliation: Casa da AIDS-Infectious Disease Division, School of Medicine, University of São Paulo, Brazil. alwerneck@uol.com.br
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Werneck-Silva
authors.forename: Ivete Bedin
authors.initials: IB
authors.lastname: Prado
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents