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

Abstract

Background 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. Objectives 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. Methods 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. Results 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. Conclusion 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.

Helicobacter pylori infection in HIV-positive patients with digestive complaints

“…Apart from this, there are studies suggesting an increase in number of non-HIV-associated digestive illnesses in HIV-infected patients during the "HAART era", concomitant to a decrease in the frequency of opportunistic infections in patients under antiretroviral therapy (19).…”

RETRACTED: Increased Risk of Stomach and Esophageal Malignancies in People With AIDS

“…This stable trend could be explained by an increase in H pylori infection or reflux disease since HAART was introduced. 54 Alternatively, these findings suggest that extended immunosuppression plays a role in the development of these cancers but that use of HAART after the development of AIDS may not be effective in halting this process. Paralleling well-described patterns in the general population, 7,8,55 we also found strong increases among people with AIDS in the incidence of esophageal and stomach cancer with older age.…”

Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

“…In recent reports of the post-HAART era, statistically significant increments were observed in the frequencies of gastroesophageal reflux disease, digestive inflammatory diseases, gastric ulcer and Helicobacter pylori infection 21 , 40 . These studies were carried out using biopsy samples.…”