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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
Article Details
References
- Monkemuller KE, Wilcox CM. Diagnosis and treatment of oesophagitis in AIDS, compr.Ther.2000, 26(3) : 163-8.
- Monkemuller KE, Call SA, Lazenby AJ, Wilcox CM. Declining prevalence of opportunistic gastro-intestinal disease in the era of combination antiretroviral therapy. Am J Gastroenterol.2000, 95: 457-462.
- Ankouane Andoulo F, Olinga Medjo U, Hadja H, Djapa R, Ndjitoyap Ndam EC. Tracheo-esophageal fistula in highly active antiretroviral therapy patient with AIDS. OA Case Reports 2013 Sep 10;2(11):103.
- Monkemuller KE, Lazenby AJ, Lee DH, London R, Wilcox CM. Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy. Dig Dis. Sci; 50: 230-234.
- Schechter M, Tubor SH. Discordant immunological and virological responses to antiretroviral therapy. J antimicrob. Chemother 2006; 58: 506-510.
- Pagano G, Dodi F, Camera M, Passalacqua G, Malfatto E, De Maria A. tubercular tracheooesophageal fistulas in AIDS patients: primary repair and no surgery. AIDS.2007, 21(18): 2561-4.
- Werneck-Silva AL Prado IB. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients. World J Gastroenterol.2009, 15(9):1050-6.
- Wilcox CM, Straub RF, Schwartz DA. Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esoephageal ulcer. Gastrointest Endosc. 1996, 44(5): 587-93.
- Werneck-Silva AL. Gastroduodenal biopsies in normal mucosa of HIV patients with dyspepsia: is it worthwhile? Gastrointest Endosc 2005; 61: AB158..
- Rerknimitr R, Kullavanijaya P. Endoscopy in HIV infected patient. J Med Assoc Thai.2001 Jun; 84 Suppl 1: s26-31.
- Wilcox CM, Straub RF, Alexander LN, Clark WS. Etiology of oesophageal disease in human immunodeficiency virus-infected patients who fail antifungal therapy. Am J Med 1996; 101: 599-604.
- Reeders. JW, Yee J, Gore RM, Miller FH, Megibow AJ. Gastrointestinal infection in the immunocompromised (AIDS) patient. Eur radiol 2004; 14 Suppl 3: E84-E102.
- Wilcox CM, Diehl DL, Cello JP, Margaretten W, Jacobson MA. Cytomegalovirus esophagitis in patient with AIDS. A clinical, endoscopic, and pathologic correlation. Ann intern Med 1990; 113: 589-593.
- Chrenpreis ED, Bober DI. Idiopathic ulceration of the esophagus in HIV-infected patients: a review. Int STD AIDS. 1996 Mar-Apr; 7(2): 77-81.
References
Monkemuller KE, Wilcox CM. Diagnosis and treatment of oesophagitis in AIDS, compr.Ther.2000, 26(3) : 163-8.
Monkemuller KE, Call SA, Lazenby AJ, Wilcox CM. Declining prevalence of opportunistic gastro-intestinal disease in the era of combination antiretroviral therapy. Am J Gastroenterol.2000, 95: 457-462.
Ankouane Andoulo F, Olinga Medjo U, Hadja H, Djapa R, Ndjitoyap Ndam EC. Tracheo-esophageal fistula in highly active antiretroviral therapy patient with AIDS. OA Case Reports 2013 Sep 10;2(11):103.
Monkemuller KE, Lazenby AJ, Lee DH, London R, Wilcox CM. Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy. Dig Dis. Sci; 50: 230-234.
Schechter M, Tubor SH. Discordant immunological and virological responses to antiretroviral therapy. J antimicrob. Chemother 2006; 58: 506-510.
Pagano G, Dodi F, Camera M, Passalacqua G, Malfatto E, De Maria A. tubercular tracheooesophageal fistulas in AIDS patients: primary repair and no surgery. AIDS.2007, 21(18): 2561-4.
Werneck-Silva AL Prado IB. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients. World J Gastroenterol.2009, 15(9):1050-6.
Wilcox CM, Straub RF, Schwartz DA. Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esoephageal ulcer. Gastrointest Endosc. 1996, 44(5): 587-93.
Werneck-Silva AL. Gastroduodenal biopsies in normal mucosa of HIV patients with dyspepsia: is it worthwhile? Gastrointest Endosc 2005; 61: AB158..
Rerknimitr R, Kullavanijaya P. Endoscopy in HIV infected patient. J Med Assoc Thai.2001 Jun; 84 Suppl 1: s26-31.
Wilcox CM, Straub RF, Alexander LN, Clark WS. Etiology of oesophageal disease in human immunodeficiency virus-infected patients who fail antifungal therapy. Am J Med 1996; 101: 599-604.
Reeders. JW, Yee J, Gore RM, Miller FH, Megibow AJ. Gastrointestinal infection in the immunocompromised (AIDS) patient. Eur radiol 2004; 14 Suppl 3: E84-E102.
Wilcox CM, Diehl DL, Cello JP, Margaretten W, Jacobson MA. Cytomegalovirus esophagitis in patient with AIDS. A clinical, endoscopic, and pathologic correlation. Ann intern Med 1990; 113: 589-593.
Chrenpreis ED, Bober DI. Idiopathic ulceration of the esophagus in HIV-infected patients: a review. Int STD AIDS. 1996 Mar-Apr; 7(2): 77-81.