What is AIDS cholangiopathy? How do patients present? AIDS cholangiopathy is a spectrum of biliary tract abnormalities resembling sclerosing cholangitis that can be caused by a wide array of microorganisms and neoplasms, usually in patients with advanced immunodeficiency (CD4 count < 100 cells/mL). Patients generally present with epigastric or right upper quadrant pain, fever, and …
What biopsy technique should be used to sample an esophageal ulcer? The exact number of biopsies required for maximal sensitivity and specificity is not clearly established, but several studies suggest the range of 8 to 10 . It is important to obtain biopsy samples from the ulcer margin and from the ulcer base. This is because biopsy …
What are the most common causes of esophageal ulceration in HIV-infected patients? The most common causes are CMV and idiopathic esophageal ulcer (IEU). On endoscopy, CMV and IEU appear most often as multiple, large, well-circumscribed solitary ulcerations, with normal-appearing surrounding mucosa. Herpes simplex virus (HSV) is usually associated with multiple small, shallow esophageal ulcerations, often …
What is the role of empiric therapy for upper GI symptoms in HIV infected patients? With improving HIV and AIDS therapies, patient commonly have CD4 counts higher than 200 cells/mL. In these patients, an empiric trial of a proton pump inhibitor is reasonable for symptoms consistent with gastroesophageal reflux disease (GERD) or other dyspeptic complaints. …
What is the role of empiric therapy for new-onset esophageal symptoms in patients with HIV infection? Candida esophagitis is the most common cause of esophageal disease in patients with AIDS presenting with dysphagia or odynophagia. Because of this high prevalence, an empiric approach to new-onset esophageal symptoms with potent antifungal therapy is commonly undertaken and accepted. …
Role of empiric therapy for new onset esophageal symptoms in HIV Read More »
How has highly active antiretroviral therapy (HAART) altered the incidence of opportunistic GI disorders? Since the introduction of protease inhibitors and HAART in 1995, there has been a constant and dramatic decline of all GI opportunistic disorders (ODs) in AIDS patients. In addition, HAART has also been shown to indirectly treat many GI ODs. Once …
How has HAART altered the incidence of opportunistic GI disorders Read More »
What is the role of endoscopy in HIV-infected patients with upper gastrointestinal (GI) symptoms? Patients with AIDS (CD4 count < 200) are at risk for opportunistic infections and neoplasms, particularly when the CD4 lymphocyte count falls to less than 100. Given the broad differential diagnosis of upper GI symptoms in these patients, generally upper endoscopy …