PREVALENCE AND ETIOLOGY OF GASTRODUODENAL ULCER IN HIV-POSITIVE PATIENTS - A COMPARATIVE-STUDY OF 497 SYMPTOMATIC SUBJECTS EVALUATED BY ENDOSCOPY

Objective: In 497 HIV-positive (+)patients with upper digestive tract symptoms, 23 (5%) had gastroduodenal ulcers (GDU) at upper endoscopy. Methods: To establish the causes of GDU in this setting, 16 of these p atients who had had comprehensive histological evaluation (group I) me re compared with 20 HIV+ subjects with upper gastrointestinal symptoms but without ulcer (group II), and with 16 seronegative patients with GDU (group III). Eighty-one percent of group I subjects and 90% of gro up II patients had C3 AIDS. The presence of gastritis and Helicobacter pylori, fungi, mycobacteria, viruses (especially cytomegalovirus [CMV ] and herpes simplex [HSV]), and parasites was determined in all three groups by histopathological and microbiological studies. Results: The prevalence of chronic active gastritis was 13/16 (81%) in group I, 12 /20 (60%) in group II, and 15/16 (94%) in group III. It was associated with H. pylori in group LII, and with opportunistic pathogens in grou ps I and II and with none in group III. H. pylori was detected in 5/16 patients (31%) in group I, in 12/20 (60%) in group II, and 11/16 (69% ) in group III. Cytomegalovirus was histologically diagnosed in 8/16 p atients (50 %) in group I and in 1/20 (5 %) in group II. This virus wa s the only factor shown to be significantly associated with GDU in the se cases (p = 0.0046). Cryptosporidium was found in 2/16 (12.5%) patie nts in group I, in 1/20 (5%) in group II, and in none in group III. Di fferences between groups I and II were not statistically significant. No other organisms mere observed in the three groups. Conclusions: Gas troduodenal ulcers were infrequent in HIV+ subjects,vith upper digesti ve tract symptoms and CMV was the only organism significantly associat ed with GDU in HIV+ patients. Among HIV+ patients, H. pylori was an un common cause of ulcer. Among HIV+ subjects,vith ulcer, chronic active gastritis was more common than H. pylori and it was associated with ot her pathogens. Finally, HIV+ patients with GDU should have endoscopic biopsies to detect opportunistic infections, especially CMV, because H . pylori infection is uncommon. (C) 1998 by Am. Coll. of Gastroenterol ogy.