Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy

The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995.

The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations.

A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology.

When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy.

These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.