Clinic of Hepato-gastroenterology, CHU Saint Pierre, Brussels, Belgium.
HIV Med. 2010 Jul 1;11(6):412-7. doi: 10.1111/j.1468-1293.2009.00807.x. Epub 2010 Feb 8.
The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995.
The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations.
A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology.
When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy.
These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.
自 1995 年广泛引入高效抗逆转录病毒疗法（HAART）以来，目前的文献表明，HIV 感染者的机会性疾病有所减少。
本研究旨在探讨 HAART 和 CD4 淋巴细胞计数对上消化道（UGI）疾病、消化症状以及内镜和组织学观察的影响。
对 706 例接受 GI 内镜检查的 HIV 感染患者进行了回顾性分析。该队列分为三组：第 1 组（G1），即未接受 HAART 治疗组，共 239 例，内镜检查时间为 1991 年 1 月至 1994 年 12 月；第 2 组（G2），即早期 HAART 治疗组，共 238 例，内镜检查时间为 1999 年 1 月至 2002 年 12 月；第 3 组（G3），即近期 HAART 治疗组，共 229 例，内镜检查时间为 2005 年 1 月至 2008 年 12 月。研究参数包括年龄、性别、机会性化学预防、抗逆转录病毒治疗、CD4 细胞计数、症状、首次 UGI 内镜检查和组织学表现。
当比较 G1、G2 和 G3 时，随着时间的推移，以下参数显著增加：女性比例、平均 CD4 细胞计数、反流症状、胃食管反流病（GERD）、炎症性胃病、胃溃疡和幽门螺杆菌（HP）感染的频率。抗机会性感染预防、咽痛/吞咽困难、急性/慢性腹泻、念珠菌性食管炎、非特异性食管溃疡和卡波西肉瘤的发生率显著降低。其他参数，如消化道出血、十二指肠溃疡和炎症性十二指肠炎，没有显著变化。
这些结果表明，随着抗病毒治疗效率的提高导致免疫功能的改善，艾滋病患者中消化系统疾病的频率降低，主要是机会性疾病。然而，在 HAART 时代，HP 感染、反流症状和 GERD 的发生率增加。
