Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, March 20, 2000
Prepared by AIDS Weekly editors from staff and other reports
Opportunistic disorders (OD) are the most frequent gastrointestinal (GI) manifestations in AIDS patients.
"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," K.E. Monkemuller and colleagues wrote ("Declining prevalence of opportunistic gastrointestinal disease in the era of combination antiretroviral therapy," Am J Gastroenterol 2000 Feb;95(2):457-62.
From April 1995 through March 1998, all 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: April 1995 to March 1996; group II: April 1996 to March 1997; and group III: April 1997 to March 1998.
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 CD4 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).
"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," Monkemuller et al. wrote.
The corresponding author for this study is K.E. Monkemuller, Department of Medicine, University of Alabama at Birmingham, 35294-0007.
This article was prepared by AIDS Weekly editors from staff and other reports.
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