Role of Upper Gastrointestinal Endoscopy in Patients with Human Immunodeficiency Virus Infection in the Era of Combination Antiretroviral Therapy

Abstract

Background Gastrointestinal (GI) diseases are common in patients with human immunodeficiency virus (HIV) infection. There are few reports on the epidemiology and endoscopic findings of gastric cancer in patients with HIV infection in the era of combination antiretroviral therapy (cART). We retrospectively analyzed upper GI endoscopic findings in patients with HIV infection and investigated their role as gastric cancer screening. Materials and Methods We retrospectively investigated endoscopies conducted in Korean patients with HIV infection referred for endoscopy at a tertiary hospital between January 2004 and December 2018. Endoscopic and pathologic findings were analyzed according to the reason for endoscopy, patient age, and cART duration. All endoscopic findings were reevaluated by gastroenterologists. Results Three hundred ten endoscopies in 201 patients with HIV infection were investigated. Of these, 118 (38.1%) endoscopies in 81 (40.1%) patients were performed for cancer screening purposes. Gastric cancer was found in 4 patients (2.0%); one of them presented with gastric cancer at the time of HIV diagnosis, and the other 3 patients were diagnosed with early gastric cancer on screening endoscopy, which was cured with endoscopic submucosal dissection or surgery. The prevalence of gastric cancer in screening endoscopies was 3.7%. Atrophic gastritis was a more common finding in screening endoscopies than in diagnostic endoscopies ( P <0.001), and was significantly associated with longer durations of cART ( P <0.001). The overall prevalence of gastric cancer, atrophic gastritis, and intestinal metaplasia was 2.0, 57.8, and 25.4%, respectively. The prevalence of atrophic gastritis and intestinal metaplasia increased with age. Conclusion Regular gastric cancer screening might be useful for early diagnosis and treatment of gastric cancer in patients with HIV infection.

Role of Bacterial and Viral Pathogens in Gastric Carcinogenesis

“…Infections with human retroviruses HIV (human immunodeficiency virus) or HTLV (human T-cell lymphotropic virus) increase the risk of developing various tumors, and can also indirectly affect gastric tumorigenesis [ 234 , 235 ]. HIV infection, if left untreated, leads to acquired immunodeficiency syndrome, a disease characterized by immune suppression and loss of immune-mediated control against diverse opportunistic pathogens.…”

“…Sixty percent of HIV-infected patients were positive for antibodies to EBV early antigen (EA) compared to 12% of uninfected individuals [ 237 ]. GC precursor lesions, including intestinal metaplasia and atrophic gastritis, were also common in patients infected with HIV [ 234 ]. In contrast to HIV, a large population-based study of HTLV-1-infected subjects found a reduced risk of GC development [ 238 ].…”

The role of gastric microecological dysbiosis in gastric carcinogenesis

“…In addition to EBV, various other viruses have been found to contribute to tumorigenic changes in the stomach. These viruses include John Cunningham virus (JCV) ( Murai et al, 2007 ), human cytomegalovirus (HCMV) ( Jin et al, 2014 ; Fattahi et al, 2018 ; Kosari-Monfared et al, 2019 ), hepatitis B (HBV) or C (HCV) viruses ( Song et al, 2019 ; Cui et al, 2020 ; Huang et al, 2020 ), human immunodeficiency virus (HIV) or human T-cell lymphophilic virus (HTLV) (Matsumoto et al, 2018; Kang et al, 2019 ; Schierhout et al, 2020 ), and papillomavirus (HPV) ( Zeng et al, 2016 ; Bozdayi et al, 2019 ).…”

Issues Related to the Treatment of H. pylori Infection in People Living with HIV and Receiving Antiretrovirals

“…The frequency of these complications is influenced by various factors including immune characteristics. Duodenal and gastric ulcers appear to be less frequent in PLWH than in the general population, while gastric cancer has been reported to be 1.8-fold more frequent in PLWH than in the general population in South Korea, a region with a high risk of gastric cancer [3,8].…”