title: Esophageal ulcer in Brazilian patients with HIV: prevalence and comparative analysis among diagnostic methods.
abstract: Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.
authors.affiliation: Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. m.brunaldi@usp.br
authors.forename: Mariângela Ottoboni
authors.initials: MO
authors.lastname: Brunaldi
authors.forename: Rosamar Eulira Fontes
authors.initials: RE
authors.lastname: Rezende
authors.forename: Sérgio Britto
authors.initials: SB
authors.lastname: Garcia
authors.forename: Alcyone Artioli
authors.initials: AA
authors.lastname: Machado
authors.forename: José Luiz Pimenta
authors.initials: JL
authors.lastname: Módena
authors.forename: Sérgio
authors.initials: S
authors.lastname: Zucoloto
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D016099:Endoscopy, Gastrointestinal; D004801:Eosine Yellowish-(YS); D004935:Esophageal Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006416:Hematoxylin; D006561:Herpes Simplex / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012680:Sensitivity and Specificity; D018139:Simplexvirus / Q000302:isolation & purification; D014456:Ulcer / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology
chemical_list: D004801:Eosine Yellowish-(YS); D006416:Hematoxylin