A multicenter case-controlled study of percutaneous endoscopic gastrostomy in HIV-seropositive patients

Malnutrition is an important cause of morbidity and mortality in AIDS patients. Percutaneous endoscopic gastrostomy (PEG) is a safe and effective method of providing nutrition in HIV-seronegative patients who are unable to swallow food, but have an otherwise functional alimentary tract. This study analyzes the risks and benefits of PEG in HIV-seropositive patients.

The risks of PEG were analyzed in 14 consecutive HIV-seropositive patients admitted to two university hospitals, and were compared with the risks in a sex- and age-matched control group of 21 patients. Thirteen HIV patients had AIDS.

PEG indications included mechanical esophageal obstruction in six, wasting in six, and central nervous system disorders in two. The mean weight of the HIV patients increased by 7.4% +/- 3.0% (SE) 3-8 wk after PEG. Despite advanced HIV infection, serum biochemical parameters of nutritional status remained stable at 3-8 wk after PEG. Nine HIV patients suffered 10 complications during a mean follow-up of 111 +/- 147 (SD) days. The HIV patients had six (43%) minor complications, whereas the controls had four (19%) minor complications (not significantly different, Fisher's exact test). Minor complications in the HIV patients included transient tenderness and erythema at the PEG site in four, transient pyrexia without a source in one, and transient ileus in one. The HIV patients had four (29%) significant complications, compared to none in the controls (p < 0.02, Fisher's exact test). Significant complications in the HIV-seropositive patients included stomal cellulitis treated with intravenous antibiotics in three, and gastric bleeding requiring transfusion of one unit of packed erythrocytes in one. None of these complications were severe; all complications rapidly resolved with therapy. The high rate of wound infection following PEG in AIDS patients, like the previously reported high rate of postoperative wound infection in AIDS patients, is attributable to immunosuppression. During the study period, four HIV patients underwent surgical gastrostomy, with one complication of severe gastrointestinal bleeding.

This work suggests that PEG is a useful and relatively safe method of providing long-term nutritional support in selected AIDS patients with a functional gastrointestinal tract.