[657] Opportunistic Diseases of the Gastrointestinal Tract in the Age of HAART

AR Huppmann, JM Orenstein. George Washington University, Washington, DC

Background: Opportunistic diseases of the GI tract have been a serious problem for the HIV/AIDS population since the very beginning of the epidemic. The introduction of highly active antiretroviral therapy (HAART) has significantly reduced their incidence in the developed world. However, for many reasons, GI symptoms still persist at a significant level. This study describes the experience of a teaching hospital pathology department with GI biopsies from symptomatic HIV/AIDS patients since the advent of HAART.
Design: GI biopsies from upper (EGD) and lower GI endoscopies were prepared at 3 levels and examined by the same pathologist who examined all of our GI biopsies from this patient population since the beginning of the epidemic. Special stains or IHC, i.e., Giemsa, GMS, PAS, CMV, and HSV-1, were performed in select cases.
Results: Between 1996 and 2008, 992 individual GI biopsies were taken during 442 endoscopies performed on symptomatic HIV-positive patients. The highest yield of specific diagnoses was from the esophagus (48%), followed, in order, by the stomach (20%), small intestine (19%), colon (14%), and rectum (9%). As before HAART, a variety of diagnoses were rendered, most commonly CMV and esophageal candidiasis, followed by H. pylori, cryptosporidiosis, reflux esophagitis, and atypical mycobacterial infection. Symptoms that were most likely to result in a diagnostic biopsy were odynophagia/dysphagia, followed by abdominal pain, nausea/vomiting, and diarrhea.

Specific diagnoses by specimen site

Diagnosis (# patients)	Esophagus	Stomach	Small intestine	Colon	Rectum	Total # biopsies
CMV (32)	15	4	2	19	5	45
Candida (32)	38	1				39
HSV (5)	4				1	5
Adenovirus (4)				4
Cryptosporidiosis (10)	1	2	7	8		18
Isospora (3)			3			3
Microsporidiosis (2)			3			3
Cryptococcus (1)	1					1
Giardia (1)			1			1
MAC (7)			5	5		10
Spirochetosis (5)				5	1	6
Pseudomembranous colitis (2)				1	1	2
H. pylori (18)		23				23
Bacteria (4)				5		5
Kaposi sarcoma (7)		4	1	1	1	7
Lymphoma (4)		1	1	3	1	6
Carcinoma (3)		1	1	1		3
Reflux (19)	21					21

Conclusions: Even in the post-HAART era, GI endoscopy with biopsy remains an important diagnostic procedure in symptomatic HIV-positive patients. Esophageal biopsy was the most diagnostically fruitful in our institution. H. pylori is now the most often diagnosed gastric process. The pathologist must still be capable of diagnosing a wide variety of opportunistic processes in this patient population.
Category: Gastrointestinal

Monday, March 22, 2010 1:00 PM

Poster Session II # 82, Monday Afternoon