Introduction. The digestive tract is invariably affected in HIV-infected patients and should be investigated especially in patients with longer disease duration. The significance of decreasing CD4+ cell counts as a predictive factor for the existence and severity of upper gastrointestinal lesions has been previously evaluated in some studies, that demonstrated a link between this parameter and the frequency or extent of esophageal or gastric lesions.
The objective of the study was to investigate the upper digestive tract infections in HIV-infected patients and to establish the link between endoscopic changes (type and location) and the peripheral CD4+ cell counts.
Material and methods. This is a retrospective cohort study. 88 HIV-infected patients, hospitalized for clinical and biological evaluation between November 2015 and July 2018 in the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania, were investigated by upper digestive endoscopy. In all patients, CD4+ T-lymphocyte values were determined.
Results. Our study emphasizes a greater probability of developing lesions of the upper digestive tract and a greater frequency of esophagitis in HIV-infected patients with low CD4+ T-lymphocyte values compared to patients with normal values. The most commonly involved segment is the esophagus. The most common gastric lesion is gastritis, which in patients with lymphocytic depletion affects the entire gastric mucosa.
Conclusions. The results of the study support the necessity of routine evaluation by upper digestive endoscopy of HIV-infected patients with low CD4+ T-lymphocyte values, irrespective of the presence or absence of symptoms specific for upper digestive tract lesions, both for diagnostic and epidemiological purposes.
Keywords: HIV, digestive lesions, endoscopy, CD4+ T-lymphocyte.
Abbreviations: HIV – Human Immunodeficiency Virus; SHIV- Simian/Human Immunodeficiency Virus; HAART – Highly Active Antiretroviral Therapy; IDO – indoleamine 2,3-dioxygenase; CMV – Cytomegalovirus; HSV – Human Simplex Virus; HHV – Human Herpes Virus; GERD – Gastroesophageal Reflux Disease; PHG – Portal Hypertensive Gastropathy; EV – esophageal varices.
Address for correspondence:
Camelia C. DIACONU
Address: Clinical Emergency Hospital of Bucharest, 8 Calea Floreasca, Bucharest, Romania