GASTROINTESTINAL-DISEASE DUE TO CYTOMEGAL OVIRUS IN PATIENTS WITH AIDS

Objetive: To describe all the clinical settings, endoscopic findings a nd response to therapy in a serie of HIV-positive patients with biopsy proven gastrointestinal CMV disease. Patients: We retrospectively rev iewed the medical records of all HIV-infected patients who underwent d igestive endoscopies at our Hospital from June 1990 to October 1993. R esults: Twelve (7.5%) of 158 HIV-positive patients had gastrointestina l CMV disease. Sites of prove infection included the esophagus (n = 6, 50%), stomach (n = 2, 17%), duodenum (n = 4, 33.3%), ileum (n = 1, 8. 5%) and colon (n = 2, 17%). The most common endoscopic findings were f ocal or diffuse mucosal ulcers. Three patients had pseudotumoral mucos al lesions, Cytomegalic cells were observed in 11 patients (91.6%) and immunohistochemical staining was positive in 9 (81.8%) of 11 patients tested. Eight patients completed a course of treatment with ganciclov ir or foscarnet and all of them showed clinical improvement. The media n survival time of our AIDS patients with CMV gastrointestinal disease was 7 weeks (range 1-39 weeks). Conclusions: Gastrointestinal CMV dis ease may damage any site of the digestive tract in AIDS patients. Rout ine histopathologic examination was better than inmunohistochemical st aining for the diagnosis. Treatment improves the clinical situation in most of them. The mean survival is low and it is related to the degre e of immunosupression.