Intestinal disease in acquired immunodeficiency: evaluation by CT

Area of Science:

• Gastroenterology
• Infectious Diseases
• Radiology

Background:

• Intestinal symptoms are common in patients with Acquired Immunodeficiency Syndrome (AIDS).
• Accurate diagnosis of gastrointestinal pathology is crucial for managing immunocompromised patients.

Purpose of the Study:

• To evaluate the utility of computed tomography (CT) in diagnosing intestinal diseases in AIDS patients.
• To correlate CT findings with colonoscopy, histology, CD4 T-lymphocyte counts, and patient survival.

Main Methods:

• Review of 339 abdominal CT exams for signs of intestinal disease.
• Comparison of CT findings with colonoscopy and histologic data in 45 AIDS patients.
• Correlation of CT results with CD4 T-lymphocyte counts and survival outcomes.

Main Results:

• CT detected signs of enteric disease in over 14% of all abdominal CT exams.
• CT identified intestinal disease in 78% of symptomatic AIDS patients compared to colonoscopy and histology.
• CMV colitis and unspecific colitis showed similar CT and colonoscopic findings; neither reliably distinguished histologic subgroups.
• Low CD4 counts and ascites on CT were indicators of poor prognosis.

Conclusions:

• CT is a valuable tool for detecting abdominal disease in immunocompromised patients, including small bowel and extraintestinal manifestations.
• While CT detects disease, findings are often unspecific, necessitating further investigation.
• Colonoscopy and biopsies have limitations in sensitivity and specificity, complicating direct comparison with CT.
• Prognostic indicators include low CD4 counts and ascites, independent of specific endoscopic or histologic findings.