Olmos Martín Alejandro, Losso Marcelo, Ruvinsky Silvina, Velázquez Alberto, Augustovski Federico
Médico de Planta de la División de Gastroenterología, Hospital Fernández, Argentina.
Acta Gastroenterol Latinoam. 2005;35(3):155-61.
Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era.
To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART.
Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea.
In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival.
In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.
即使在高效抗逆转录病毒治疗（HAART）时代，慢性腹泻仍是艾滋病患者难以处理的问题。
为开始接受HAART治疗、CD4细胞计数低于200个/毫升且患有慢性腹泻的HIV感染患者确定最合适的诊断程序。
使用决策树作为决策分析工具，考虑了艾滋病相关慢性腹泻病因诊断的两种方案。比较的方案是最小评估（粪便培养和粪便寄生虫检查）和全面评估（增加肠道活检的内镜检查）。决策树由TreeAge Data 32软件构建。两种方案的诊断和治疗数据均来自医学出版物。结果是报告的开始接受HAART治疗、CD4水平低于200个/毫升且有或无慢性腹泻的HIV感染患者的生存估计值。
在基础分析以及敏感性分析中，全面评估是显示最高期望值的方案：生存7.79年。最小评估显示的生存值为7.05年。
对于开始接受HAART治疗、CD4细胞计数低于200个/毫升且患有慢性腹泻的HIV感染患者，采用活检样本的消化内镜检查是最佳诊断方法。
