Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections

During a 28-month period, endoscopic mucosal biopsy specimens from all HN-i nfected patients were submitted for routine histologic evaluation. Immunope roxidase staining for cytomegalovirus and herpesvirus antigens (esophagus), mycobacterial and fungal staining and cram staining of mucosal biopsy spec imens were done. Special fungal and acid-fast stains were selectively perfo rmed in patients with absolute CD4 cell counts of less than 200 cells per m icroliter (200 x 10(6)/L) and/or with diarrhea and or wasting syndrome. Tre atment was based on the endoscopic and histologic findings, and long-term f ollow-up was performed. The 121 symptomatic HIV-infected patients underwent 221 upper and/or lower endoscopies with 285 biopsy sites. The sensitivity and specificity of H&E staining for the diagnosis of gastrointestinal cytom egalovirus were 97% and 100%, respectively. The results of fungal and mycob acterial stains neither altered therapy nor identified previously undiagnos ed infections in any patient. Long-term follow-up revealed no patient in wh om an infection was missed on routine H&E, which affected outcome. Routine H&E staining is accurate for the diagnosis of gastrointestinal opportunisti c infections in HN-infected patients. Special histologic stains for fungal, mycobacterial, and viral infections did not increase the diagnostic yield or alter medical therapy but doubled the costs.