AEGiS-09IAC: The causes and prognosis of oesophageal ulceration in patients with HIV infection.

9th International AIDS Conference

Berlin, Germany — June 6-11, 1993

The causes and prognosis of oesophageal ulceration in patients with HIV infection.

Int Conf AIDS 1993 Jun 6-11; 9:446 (abstract no. PO-B19-1865)
Churchill DR, Edgecombe J, McGowan I, Miller RF; Department of Medicine, Middlesex Hospital, London.

OBJECTIVE: To establish the causes, prognosis and response to treatment of patients with oesophageal ulceration and HIV infection.

METHODS: Retrospective study of patients with HIV infection and oesophageal ulceration at endoscopy.

RESULTS: 22 patients (all gay men) with discrete oesophageal ulceration were identified from a database of 202 endoscopies performed on patients with HIV. All patients underwent biopsy for histology with immunohistochemical staining of sections where indicated. The causes of ulceration were: Cytomegalovirus (CMV) infection (11 patients), Non-Hodgkin's lymphoma (2 patients), Herpes simplex virus (1 patient), and CMV and oesophageal hairy leukoplakia (1 patient). In the remaining 7 patients no infective cause of ulceration was found. Of 15 patients with a specific diagnosis, one endoscopy was needed to make the diagnosis in 13 patients; the remaining patients had 2 and 5 procedures before a specific diagnosis. 20/22 patients had a prior AIDS diagnosis. 11 patients with CMV ulceration were treated with ganciclovir; 2 received foscarnet after neutropenia due to ganciclovir and relapse of ulceration. Symptomatic improvement occurred in all patients treated for CMV; endoscopic resolution was documented in 5/8 undergoing repeat endoscopy. Of the 7 patients with non-specific histology, 2 later developed CMV infection at another site and received ganciclovir, 1 had a previous history of pharyngeal aphthous ulceration and responded to corticosteroids, and the remaining four were treated with H2 antagonists without documented ulcer healing. Mean survival after diagnosis of ulceration was 6.3 months (range 0-14 months).

CONCLUSIONS: CMV is the commonest cause of oesophageal ulceration in HIV. The prognosis of oesophageal ulceration is poor, reflecting underlying immunosuppression from HIV.

Keywords: AEGIS, HIV Infections, Esophageal Diseases, Cytomegalovirus Infections, Ganciclovir, Prognosis, Foscarnet, Acquired Immunodeficiency Syndrome, Cytomegalovirus, Esophagitis, Ulcer, Peptic Ulcer, Leukoplakia, Hairy, Retrospective Studies, Human, Male, etiology, diagnosis, ICA9
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POB191865