A multicenter, case-controlled study of the clinical presentation and etiology of ascites and of the safety and clinical efficacy of diagnostic abdominal paracentesis in HIV seropositive patients.

OBJECTIVE

To analyze the clinical presentation and etiology of ascites in HIV seropositive patients compared with the general population and to analyze the safety and clinical efficacy of abdominal paracentesis in HIV patients.

METHODS

We did a multiyear study of 24 HIV seropositive and 60 control patients with ascites undergoing diagnostic abdominal paracentesis at two university hospitals.

RESULTS

HIV seropositive patients presented with similar clinical findings as other patients with ascites, except HIV patients had a significantly higher incidence of pyrexia and a lower serum albumin level and leukocyte count. The two groups had similar mean ascitic fluid values of lactate dehydrogenase, total protein, glucose, and erythrocyte count. HIV patients had a trend of a higher rate of infected ascites than controls (29% vs 12%; odds ratio = 3.12; odds ratio confidence interval = 0.80-12.3; p < 0.06; chi 2). HIV and control patients with culture-proven bacterial peritonitis had similar ascitic fluid leukocyte and absolute neutrophil counts. In eight (33%) of the HIV patients, major new diagnoses were made from ascitic fluid analysis, including spontaneous bacterial peritonitis in four, tuberculous ascites in two, fungal peritonitis in one, and lymphoma in one (control rate = 30%; not significantly different; chi 2). The HIV patients did not experience any complications from paracentesis, whereas the controls experienced one minor complication of prolonged drainage of ascitic fluid from the paracentesis site (not significantly different rates; Fisher's exact test). Six (25%) of the HIV patients had ascites caused by AIDS-defining illnesses of lymphoma, peritoneal tuberculosis, or disseminated candidiasis.

CONCLUSIONS

Abdominal paracentesis is a safe and effective clinical diagnostic tool in HIV patients. In addition to standard tests, ascitic fluid should be sent for mycobacterial and mycological histological stains and cultures in HIV patients. AIDS-unrelated causes are the most common cause of ascites in HIV patients, with only about 1/4 of cases due to AIDS-related diseases.