Use of CD4 cell counts of HIV-infected patients as a sensitive predictor of opportunistic infectious findings at upper gastrointestinal endoscopy

Academic Article

Abstract

  • The endoscopic yield for opportunistic disorders is higher in HIV-infected patients who are CDC class IV. However, prior reports have not demonstrated a statistical correlation between CD4 cell counts and opportunistic findings (01) at upper gastrointestinal endoscopy (EGD) Purpose: Our aim was to determine at what level CD4 cell counts of HIV-infected patients accurately predicted opportunistic lesions found at EGD. Methods; Consecutive patients with HIV infection undergoing EGD from 8/1/90 through 12/31/93 were prospec-tively identified and CD4 cell counts recorded All endoscopic abnor-malities were routinely biopsied. Patients who did not have a CD4 cell count measured within 30 days prior to EGD were excluded Results: During the 40 month study period, 121 patients were enrolled. The overall yield of opportunistic lesions was 65 3% (79 patients) Esophageal ulcers (CMV, 26%, idiopathic, 22%, and HSV 3%) were diagnosed in 51%, Candida in 10%, Kaposi's Sarcoma in 2%, and MAC/Cryptosporidiosis in 1% each. EGD was negative in 33 patients (27%) and revealed PUD or GERD in 9 (7%). CD4 counts ±SEM are shown in table 1 Table 1. Opportunistic Lesions Negative or GERD/PUD p-value N 79 42 CD4 count 23.5±3.6 cells/m3 174.3±25.7 cells/m3 p<.001 Utilizing a CD4 cut-off of 100 cells/m3, the sensitivity for diagnosis of an opportunistic infection was 98% (table 2) Only 2 patients (1.7%) with a CD4 count over 100 cells/m3 demonstrated opportunistic lesions at EGD, one with Candida and one with CMV There were no significant differences in CD4 counts between the various OI's diagnosed at EGD or between PUD/GERD vs. negative EGDs Table 2. Diagnostic thresholds of CD4counts for OI's at EGD. CD4 Cell Count Sensitivity Positive Predictive Value Relative Risk Ratio under 50 cells/m3 95% 85% under 100 cells/m3 98% 83% 2.55 (.56-11.70) under 200 cells/m3 100% 76% Conclusions; 1)Patients with opportunistic infections at EGD have significantly lower CD4 counts than those with PUD/GERD or negative EGDs. 2)CD4 counts of less than 100 cells/m3 appear to be an accurate predictor of opportunistic infections diagnosed at EGD. 3)CD4 counts may prove to be a useful adjunct in decision analysis for the utilization of EGD in HIV-infected patients.
  • Authors

    Published In

    Digital Object Identifier (doi)

    Author List

  • Bashir RM; Eisen GM; Wilcox CM
  • Start Page

  • 291
  • Volume

  • 43
  • Issue

  • 4