Histopathology of human immunodeficiency virus-associated esophageal disease

We evaluated the histopathologic features of the esophageal mucosa in 88 patients seropositive for human immunodeficiency virus (HIV). All patients had an upper endoscopy because of esophageal symptoms. Forceps biopsies and brushings of the esophagus were examined histologically and cytologically for evidence of viral, fungal, and mycobacterial infections: in addition, biopsies and brushings were cultured for cytomegalovirus and herpes simplex. Esophageal inflammation (acute or chronic) was graded 0 through 3. Twenty-one patients (24%) had a normal endoscopy; none displayed high grade (grade 2 and 3) acute inflammation and only two (9.5%) had high grade chronic inflammation in the esophagus. Moreover, no fungi or viral inclusions were seen in samples from these patients. Eleven patients (12%) had an abnormal esophageal mucosa but no pathogen detected and were categorized as "idiopathic esophagitis." The percent with high-grade inflammation (27%) was not significantly different from the normal group. Fifty-six patients (64%) had an infectious diagnosis. Forty-six percent had Candida, 16% had viral esophagitis alone, and one patient had Kaposi's sarcoma. Infections were associated with high-grade acute and chronic inflammation in 53% and 47% of patients, respectively. The location of the infiltrate did not predict the type of infection. In conclusion, if esophagoscopy is normal in patients with HIV infection and esophageal symptoms, a biopsy is not necessary.