Ulcères Œsophagiens et Traitements Combinés Antirétroviraux : À Propos d’un Cas

Serge Chimi Fotso, Sandra Djomo, Roger Djapa, Firmin Ankouane Andoulo

Abstract


ÉSUMÉ
À l’ère des traitements combinés antirétroviraux, les affections opportunistes digestives, notamment les ulcères œsophagiens sont de plus en plus décrits, surtout dans les pays en voie de développement. Les facteurs favorisant leur développement sont actuellement connus. L’infection au VIH de type I et l’immunodépression sévère constituent les plus évidents. Le diagnostic de ces ulcères œsophagiens est aisé en endoscopie couplée à de multiples biopsies. Parmi ces ulcères, ceux qualifiés d’idiopathiques répondent aux corticoïdes. Nous rapportons le cas d’une patiente camerounaise de 47 ans infectée par le VIH et sous traitement combiné antirétroviral depuis 8 ans, référée en endoscopie pour une dysphagie progressive aux solides et liquides avec altération de l’état général, chez qui le diagnostic d’ulcère œsophagien a été posé. Le traitement antirétroviral a été remplacé par l’association ténofovir, lamivudine, lopinavir, ritonavir en avec un inhibiteur de la pompe à protons. L’évolution a été rapidement favorable.
MOTS-CLÉS : VIH, affections opportunistes, traitement combiné antirétroviral, pays en voie de développement, endoscopie, Cameroun

ABSTRACT
In the era of highly active antiretroviral therapy (HAART), digestive opportunistic diseases, notably oesophageal ulcers are becoming more frequent, mainly in developing countries. Their risk factors are known and mostly concern HIV type 1 and severe immunosuppression. Upper digestive endoscopy coupled with routine staining of biopsied samples establishes the diagnosis of most of these ulcers. Corticosteroids are the treatment of choice of idiopathic oesophageal ulcers. We report the case of 47 years old known HIV infected Cameroonian female patient, on HAART for 8 years, who was referred for an esophagogastroduodenoscopy for long standing progressive dysphagia to both solids and liquids in the setting of severe weight loss. The diagnosis of oesophageal ulcers was established at endoscopy. The only therapeutic option undertaken was a change of her antiretroviral regimen in association with esoméprazol. Outcome was excellent. Dysphagia and odynophagia in AIDS patients should prompt the consideration of esophageal ulcers. Pathologic analysis of biopsied specimens establishes the diagnosis of these ulcers.
KEYWORDS: HIV, opportunistic diseases, combination antiretroviral therapy, low income countries, endoscopy, immunodepression, Africa, Cameroon


Keywords


HIV, opportunistic diseases, combination antiretroviral therapy, low income countries, endoscopy, immunodepressVIH, affections opportunistes, traitement combiné antirétroviral, pays en voie de développement, endoscopie, immunodépression, Afrique, Cameroun

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