Abstract
Gastrointestinal symptoms are commonly seen in patients with established AIDS. We examined the charts of 258 HIV-infected patients attending our HIV outpatient clinic to determine: (1) the frequency of gastrointestinal symptoms in unselected HIV-infected patients and (2) if there are any predictors of the development of symptoms in initially asymptomatic patients. We found the overall frequency of gastrointestinal symptoms at initial presentation in our ambulatory, predominantly homosexual population of HIV-infected patients was 35% (95% CI 30–40%) with 19% having anorexia, 15% weight loss, 14% diarrhea, and 5% dysphagia. There was no association between the presence of symptoms and stool parasites, which were found in 51% of patients. In 165 patients who were initially asymptomatic, 72% subsequently developed symptoms over 36 months of actuarial follow-up. Patients with initial T4 counts <500 were more likely to develop symptoms. Patients with a greater degree of immunosuppression as indicated by a lower T4 count, are more likely to develop gastrointestinal symptoms.
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Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA, Saxon A: Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. N Engl J Med 305:1425–1431, 1981
Gottlieb MS, Groopman JE, Weinstein WM, Fahey JL, Detels R: The acquired immunodeficiency syndrome. Ann Intern Med 99:208–220, 1983
Ullrich R, Zeitz M, Heise W, L'age M, Hoffken G, Riecken EO: Small intestinal structure and function in patients infected with human immunodeficiency virus (HIV): Evidence for HIV-induced enteropathy. Ann Intern Med 111:15–21, 1989
Quinn TC, Piot P, McCormick JB, Feinsod FM, Taelman H, Kapita B, Stevens W, Fauci AS: Serologic and immunologic studies in patients with AIDS in North America and Africa. JAMA 257:2617–2621, 1987
Dworkin B, Wormser GP, Rosenthal WS, Heier SK, Braunstein M, Weiss L, Jankowski R, Levy D, Weiselberg S: Gastrointestinal manifestations of the acquired immunodeficiency syndrome; a review of 22 cases. Am J Gastroenterol 80:774–778, 1985
Rolston KV, Rodriguez S, Hernandez M, Bodey GP: Diarrhea in patients infected with the human immunodeficiency virus. Am J Med 86:137–138, 1989
Rene E, Marche C, Regnier B, Saimot AG, Vilde JL, Perrone C, Michon C, Wolf M: Intestinal infections in patients with acquired immunodeficiency syndrome. A prospective study in 132 patients. Dig Dis Sci 34:773–780, 1989
Antony MA, Brandt LJ, Klein RS, Bernstein LH: Infectious diarrhea in patients with AIDS. Dig Dis Sci 33:1141–1146, 1988
Gelb A, Miller S: Aids and gastroenterology. Am J Gastroenterol 81:619–622, 1986
CDC classification system for human T-lymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR 35:334–339, 1986
Masur H, Ognibene FP, Yarchoan R, Shelhamer JH, Baird BF, Travis W, Suffredini AF, Deyton L, Kovacs JA, Falloon J: CD4 Counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med 11:223–231, 1989
Recommendations for zidovudine: Early infection. JAMA 263:1606–1607, 1990
Norusis, MJ. Spss/PC+4.0. Chicago, SPSS Inc., 1990
Lee E, Desu M: A computer program for comparing k samples with right-censored data. Comput Programs Biomed 2:315–321, 1972
Rodger VD, Fassett R, Kagnoff MF: Abnormalities in intestinal mucosal T cells in homosexual populations including those with the lymphadenopathy syndrome and acquired immunodeficiency syndrome. Gastroenterology 90:552–558, 1986
Sutherland LR, Church DL, Gill MJ, Kelly JK, Hwang WS, Bryant HE: Gastrointestinal function and structure in HIV-positive patients. Can Med Assoc J 143:641–646, 1990
Connolly GM, Forbes A, Gazzard BG: Investigation of seemingly pathogen-negative diarrhoea in patients infected with HIV1. Gut 31:886–889, 1990
Gillin JS, Shike M, Alcock N, Urmacher C, Krown S, Kurtz RC, Lightdate CJ, Winawer SJ: Malabsorption and mucosal abnormalities of the small intestine in the acquired immunodeficiency syndrome. Ann Intern Med 102:619–622, 1985
Connolly GM, Shanson D, Hawkins DA, Harcourt Webster JN, Gazzard BG: Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients. Gut 30:195–200, 1989
Kotler DP, Gaetz HP, Lange M, Klein EB, Holt PR: Enteropathy associated with the acquired immunodeficiency syndrome. Ann Intern Med 101:421–428, 1984
Rabeneck L, Boyko WJ, McLean DM, McLeod WA, Wong KK: Unusual esophageal ulcers containing enveloped viruslike particles in homosexual men. Gastroenterology 90:1882–1889, 1985
Nelson JA, Wiley CA, Reynolds-Kohler C, Reese CE, Margaretten W, Levy JA: Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet 1:259–262, 1988
Dworkin BM, Wormser GP, Axelrod F, Pierre N, Schwarz E, Schwartz E, Seaton T: Dietary intake in patients with acquired immunodeficiency syndrome (AIDS), patients with AIDS-related complex, and serologically positive human immunodeficiency virus patients: Correlations with nutritional status. JPEN 14:605–609, 1990
Laughon BE, Druckman DA, Vernon A, Quinn TC, Polk BF, Modlin JF, Yolken RH, Bartlett JG: Prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome. Gastroenterology 94:984–993, 1988
Greenson JK, Belitsos PC, Yardley JH, Bartlett JG: AIDS enteropathy: Occult enteric infections and duodenal mucosal alterations in chronic diarrhea. Ann Intern Med 114:336–372, 1991
Volberding PA, Lagakos SW, Koch MA, Pettinelli C, Myers MW, Booth DK, Balfour Jr. HH, Reichman RC, Bartlett JA, Hirsch MS: Zidouvdine in asymptomatic human immunodeficiency virus infection. N Engl J Med 322:942–949, 1990
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May, G.R., Gill, M.J., Church, D.L. et al. Gastrointestinal symptoms in ambulatory HIV-infected patients. Digest Dis Sci 38, 1388–1394 (1993). https://doi.org/10.1007/BF01308593
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DOI: https://doi.org/10.1007/BF01308593