HUMAN IMMUNODEFICIENCY VIRUS-RELATED ABDOMINAL-PAIN IN SOUTH-AFRICA -ETIOLOGY, DIAGNOSIS, AND SURVIVAL

Background: Abdominal pain in acquired immunodeficiency syndrome (AIDS ) patients is often a marker of an underlying opportunistic pathologic condition. There are no data on HIV-related abdominal pain in Africa. Methods: Forty-four consecutive Cape Town patients with advanced huma n immunodeficiency virus (HIV) infection (CD4 < 200) and abdominal pai n were studied prospectively to determine aetiology and survival. Resu lts: A probable cause of pain was identified in 37 (84%): disseminated Mycobacterium tuberculosis infection in 11, cryptosporidiosis in 6, c ytomegalovirus infection in 6, and atypical mycobacterial infection in ?. Gastrointestinal lymphoma and pancreatitis were not seen. Fever, h epatomegaly, respiratory symptoms, abnormal chest radiograph, and aden opathy, ascites, or abscesses on ultrasound had predictive diagnostic value for disseminated M, tuberculosis. Fifty-one per cent of abdomina l pain patients survived 6 months, compared with 73% of all AIDS patie nts (P < 0.001). Conclusions: The aetiology of HIV-related abdominal p ain in Cape Town reflects the high local prevalence of tuberculosis, C linical and ultrasound features facilitate diagnosis. Abdominal pain i s associated with poor survival.