The role of upper gastrointestinal endoscopy in the era of modern antiretroviral therapy

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Abstract

Objective

Gastrointestinal disorders are common in HIV-positive patients and, in some cases, may be related to antiretroviral therapy (ART), making it difficult to determine the need for upper gastrointestinal (UGI) endoscopy. The primary aim of this study was to determine whether lymphocyte T CD4 cell counts were correlated with indications for endoscopy in these patients and with endoscopic diagnosis.

Patients and methods

We prospectively collected data from consecutive HIV-positive patients undergoing UGI endoscopy between 2007 and 2013, and included 265 patients who had been receiving ART for at least 6 months. Parameters studied were demographics, immune parameters, comorbidities, comedications, indications for endoscopy, and endoscopic, pathologic, and microbiologic findings.

Results

The most frequent indications for UGI endoscopy were gastroesophageal reflux, epigastric pain, and other. Peptic esophagitis, esophageal candidiasis, and normal endoscopy were the most common diagnoses. The prevalence rates of Helicobacter pylori infection and neoplasia were 26.4 and 1.8%, respectively. Patients with CD4+ counts 200 cells/μl or more had significantly lower rates of macrolide and nonmacrolide use, fewer comorbidities, and were less likely to have AIDS than patients with lower counts. They were also more likely to have normal UGI endoscopy and had a higher frequency of H. pylori infection. AIDS status and the presence of comorbidities were independent predictors of endoscopic abnormalities.

Conclusion

UGI endoscopy remains a key diagnostic procedure for HIV-positive patients with UGI symptoms. AIDS and comorbidities are risk factors for the presence of mucosal lesions among HIV-positive patients on ART.

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