A MULTICENTER CASE-CONTROLLED STUDY OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN HIV-SEROPOSITIVE PATIENTS

Objectives: Malnutrition is an important cause of morbidity and mortal ity in AIDS patients. Percutaneous endoscopic gastrostomy (PEG) is a s afe and effective method of providing nutrition in HIV-seronegative pa tients who are unable to swallow food, but have an otherwise functiona l alimentary tract. This study analyzes the risks and benefits of PEG in HIV-seropositive patients. Methods: The risks of PEG were analyzed in 14 consecutive HIV-seropositive patients admitted to two university hospitals, and were compared with the risks in a sex- and age-matched control group of 21 patients. Thirteen HIV patients had AIDS. Results : PEG indications included mechanical esophageal obstruction in six, w asting in six, and central nervous system disorders in two. The mean w eight of the HIV patients increased by 7.4% +/- 3.0% (SE) 3-8 wk after PEG. Despite advanced HIV infection, serum biochemical parameters of nutritional status remained stable at 3-8 wk after PEG. Nine HIV patie nts suffered 10 complications during a mean follow-up of 111 +/- 147 ( SD) days. The HIV patients had six (43%) minor complications, whereas the controls had four (19%) minor complications (not significantly dif ferent, Fisher's exact test). Minor complications in the HIV patients included transient tenderness and erythema at the PEG site in four, tr ansient pyrexia without a source in one, and transient ileus in one. T he HIV patients had four (29%) significant complications, compared to none in the controls (p < 0.02, Fisher's exact test). Significant comp lications in the HIV-seropositive patients included stomal cellulitis treated with intravenous antibiotics in three, and gastric bleeding re quiring transfusion of one unit of packed erythrocytes in one. None of these complications were severe; all complications rapidly resolved w ith therapy. The high rate of wound infection following PEG in AIDS pa tients, like the previously reported high rate of postoperative wound infection in AIDS patients, is attributable to immunosuppression. Duri ng the study period, four HIV patients underwent surgical gastrostomy, with one complication of severe gastrointestinal bleeding. Conclusion s: This work suggests that PEG is a useful and relatively safe method of providing long-term nutritional support in selected AIDS patients w ith a functional gastrointestinal tract.