The Causes of Esophageal Symptoms in Human Immunodeficiency Virus Infection: A Prospective Study of 110 Patients

doi:10.1001/archinte.1991.00400080067012

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Vol. 151 No. 8, AUGUST 1991

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The Causes of Esophageal Symptoms in Human Immunodeficiency Virus Infection

A Prospective Study of 110 Patients

Maurizio Bonacini, MD; Terry Young, MD; Loren Laine, MD

Arch Intern Med. 1991;151(8):1567-1572.

Abstract

Study Objectives.
To determine the prevalence of infectious agents in patientswith human immunodeficiency virus infection and odynophagiaor dysphagia; the utility of endoscopic, histologic, cytologic,and virologic testing for the diagnosis of esophagitis; andthe yield of blind brushings of the esophagus in this setting.

Design.
Prospective clinical case study.

setting.
Urban county hospital.

Patients.
One hundred ten consecutive patients with esophageal symptomsand documented human immunodeficiency virus infection.

Intervention.
Blind brushing of the esophagus via orogastric tube followedby endoscopy with esophageal brushings for fungal stain, Papanicolausmear, and viral cultures and esophageal biopsies for histologicexamination and viral culture.

Main Results.
Seventy-two (65%) of the 110 patients had a total of 100 esophagealinfections. Thirty-three (30%) had Candida alone, 22 (20%) hadCandida and cytomegalovirus, two (108%) had Candida with cytomegalovirusand herpes simplex virus, seven (6%) had cytomegalovirus alone,six (5%) had herpes simplex virus alone, and two (1.8%) hadboth viruses. Fifty of 55 patients with plaques alone had Candida,and two (4%) had only viral infection. Of 19 patients with erosionsor ulcers, 11 (58%) had a viral infection, two (11%) had Candidaalone, and six (30%) had no etiologic agent identified. Thesensitivity of endoscopic brushings (95%) was better than thatof histologic examination (70%) in the diagnosis of Candidaesophagitis. Likewise, viral cultures of brushings or biopsyspecimens were more sensitive (67%) than histologic examination(35%) for viral esophagitis. Blind brushing of the esophagushad a sensitivity and specificity for infectious esophagitisof 84% and 75%, respectively. Oral thrush had a sensitivityof 53% and a positive predictive value of 77% for Candida esophagitis.

(Arch Intern Med. 1991;151:1567-1572)

Author Affiliations

From the University of Southern California School of Medicine, Los Angeles.

Footnotes

Accepted for publication November 19, 1990.

Reprint requests to Gastrointestinal and Liver Diseases Division,Department of Medicine, University of Southern California, 2025Zonal Ave, Los Angeles, CA 90033 (Dr Laine).

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