Declining prevalence of opportunistic gastrointestinal disease in the era of combination antiretroviral therapy

• Published in: The American journal of gastroenterology Vol. 95; no. 2; pp. 457 - 462
• Main Authors: Monkemuller, Klaus E., Call, Stephanie A., Lazenby, Audrey J., Wilcox, C. Mel
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.02.2000
• Subjects: Gastroenterology; Human immunodeficiency virus
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2000.01768.x

OBJECTIVE:Opportunistic disorders (OD) are the most frequent GI manifestations of the acquired immunodeficiency syndrome (AIDS). Since the introduction of highly active antiretroviral therapy (HAART), there appears to be have been a reduction in the incidence of many of these OD; however, the effect of HAART on the prevalence of GI OD has not been well studied.METHODS:From 4/95 through 3/98, all HIV (HIV)-infected patients undergoing GI endoscopy were prospectively identified; mucosal biopsies were obtained in a standardized fashion and histological specimens were examined by a single GI pathologist. Patients were divided into three groups based on the time of evaluation: group I: 4/95 to 3/96; group II: 4/96 to 3/97; and group III: 4/97 to 3/98.RESULTS:A total of 166 patients (90% men; mean age 36 ± 10 yr; median CD4 lymphocyte count 62 cells/μl, range 2-884, median viral RNA level 1,357 copies/ml, range undetectable to 7,721,715) underwent 279 upper and/or lower endoscopies during the study period. There were no statistical differences in patients' demographics and indications for endoscopy although the CD 4 lymphocyte count was higher in group III. The percentage of patients receiving HAART at the time of endoscopy increased from 0% to 57% over the three periods (p < 0.01), and the percentage of patient receiving combination antiretroviral therapy increased from 37% to 82% over the study period (p < 0.01). In contrast, the prevalence of OD decreased from 69% (group I) to 13% (group III) (p < 0.01), whereas the prevalence of non-OD, including a normal endoscopy increased from 31% to 87% (p < 0.01).CONCLUSIONS:GI OD now seem to be an uncommon problem in HIV-infected patients undergoing endoscopy despite a low CD4 lymphocyte count, and this reduction of OD was associated with the use of HAART.