Infect Chemother.  2019 Mar;51(1):35-44. 10.3947/ic.2019.51.1.35.

Role of Upper Gastrointestinal Endoscopy in Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy

Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. zzanmery@gmail.com
  • 2Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Korea.
  • 3Division of Gastroenterology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.

Abstract

BACKGROUND
Gastrointestinal (GI) diseases are common in patients with human immunodeficiency virus (HIV) infection. There are few reports on the epidemiology and endoscopic findings of gastric cancer in patients with HIV infection in the era of combination antiretroviral therapy (cART). We retrospectively analyzed upper GI endoscopic findings in patients with HIV infection and investigated their role as gastric cancer screening.
MATERIALS AND METHODS
We retrospectively investigated endoscopies conducted in Korean patients with HIV infection referred for endoscopy at a tertiary hospital between January 2004 and December 2018. Endoscopic and pathologic findings were analyzed according to the reason for endoscopy, patient age, and cART duration. All endoscopic findings were reevaluated by gastroenterologists.
RESULTS
Three hundred ten endoscopies in 201 patients with HIV infection were investigated. Of these, 118 (38.1%) endoscopies in 81 (40.1%) patients were performed for cancer screening purposes. Gastric cancer was found in 4 patients (2.0%); one of them presented with gastric cancer at the time of HIV diagnosis, and the other 3 patients were diagnosed with early gastric cancer on screening endoscopy, which was cured with endoscopic submucosal dissection or surgery. The prevalence of gastric cancer in screening endoscopies was 3.7%. Atrophic gastritis was a more common finding in screening endoscopies than in diagnostic endoscopies (P <0.001), and was significantly associated with longer durations of cART (P <0.001). The overall prevalence of gastric cancer, atrophic gastritis, and intestinal metaplasia was 2.0, 57.8, and 25.4%, respectively. The prevalence of atrophic gastritis and intestinal metaplasia increased with age.
CONCLUSION
Regular gastric cancer screening might be useful for early diagnosis and treatment of gastric cancer in patients with HIV infection.

Keyword

Human immunodeficiency virus; Endoscopy; Gastric cancer; Cancer screening; Antiretroviral therapy
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