Endoscopic Manifestation in HIV Patients Presenting with Gastrointestinal Symptoms: A Descriptive Study.

Abstract

Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) due to its varied presentations and multisystem involvement has become a major cause of mortality and morbidity encountered in practice of modern medicine. A large proportion of patients with HIV-AIDS present with a wide spectrum of gastrointestinal symptoms during the course of the disease 1 .Studies on the prevalence of GI symptom, diagnosis, endoscopic findings and management in the Indian population is lacking. Hence we studied the clinical and endoscopic manifestations in HIV infected patients with upper GI symptoms. This is a cross sectional descriptive study of upper endoscopic findings in HIV infected patients presenting with upper gastro-intestinal symptoms to the tertiary center multi-specialty hospital of 1100 beds. We studied 55successive HIV infected patients who underwent Esophagogastroduodenoscopy from 1september 2011 to 31 august 2012. The mean age of the subjects was 43.76 years. There were 37 (67.27%) males and 18 (32.73%) females. In our study, of the 55 patients 30(70.91%) had a CD4 count of<200. While 11(20%) had a CD4 count between 200-499, 5(9.09%) patients had a CD4 count of 500 or less. Dysphagia(26%) was found to be the most commonly appearing symptom followed by vomiting(23%), dyspepsia(19%),nausea(19%) and epigastric pain(12%).Idiopathic oesophageal ulceration was the most common pathology noted followed by CMV, Hiatus hernia, Oesophageal candidiasis and Oesophageal varices .Idiopathic oesophageal ulceration though not being among the opportunistic infections was the most common finding in our study. There was no significant correlation between the presence of an endoscopic finding with CD4 counts. However, in our study, we noted that there was a significant correlation between clinical stage and probability of a positive endoscopic finding. Idiopathic Oesophageal Ulceration was found to be the most common endoscopic finding among patients with HIV presenting with upper GI symptom .This study has noted that oesophageal candidiasis was not the most common endoscopic finding among HIV patients with upper GI symptoms. This could be attributed to empiric treatment with antifungals and early diagnosis and optimal treatment of HIV. Hence even though the prevalence of oesophageal candidiasis might remain the same, it is less often seen during regular endoscopies than before.CMV involvement of the upper GI tract was found to be more common in patients on HAART unlike the rest of the endoscopic findings. This could be attributed to the relatively longer mean duration of the disease and the significantly lower CD4counts in this subset. Treatment failure and progression of the disease could have contributed to this situation. Endoscopic findings increase as the disease progresses.