Human immunodeficiency virus (HIV) is highly associated with giant idiopathic esophageal ulcers in acquired immunodeficiency syndrome (AIDS) patients

Abstract

Objective: This study aimed to determine whether the human immunodeficiency virus (HIV) exists in giant idiopathic esophageal ulcers in the patients with acquired immune deficiency syndrome (AIDS).

Methods: 16 AIDS patients with a primary complaint of epigastric discomfort were examined by gastroscopy. Multiple and giant esophageal ulcers were biopsied and analyzed with pathology staining and reverse transcription-polymerase chain reaction (RT-PCR) to determine the potential pathogenic microorganisms, including HIV, cytomegalovirus (CMV) and herpes simplex viruses (HSV).

Results: HIV was detected in ulcer samples from 12 out of these 16 patients. Ulcers in 2 patients were infected with CMV and ulcers in another 2 patients were found HSV positive. No obvious cancerous pathological changes were found in these multiple giant esophageal ulcer specimens.

Conclusion: HIV may be one of the major causative agents of multiple benign giant esophageal ulcers in AIDS patients.

Keywords: AIDS; CMV; HIV; HSV; endoscopy; esophageal ulcer.

Figure 1

Appearances of esophagus ulcers in HIV infected patients. Endoscopic photos were taken from all 16 patients with EU, and their representative endoscopic images were shown and categorized into the following A to H types. A. Esophagus huge gap-like ulcers, sharp edge, dry-river presentation, the depth of the ulcer reached the muscular layer, which is long and wide with hyperemia and edema but clean bottom, huge superficial ulcers are also found on the opposite side. B. Esophagus huge connecting ulcer covered with white moss, peripheral esophageal mucosal congestion and edema. C. Esophagus with multiple coin-like depressed ulcers surrounding the entire esophagus, red muscle is visible at the bottom of the large mucous membrane and the bottom has no obvious moss. D. Burn like esophageal huge deep ulcer with light yellow moss. E. Multiple bar or oval-like ulcers, partially fused to a larger slice of ulcer, deeper to the submucosal, muscle layer is visible. F. Gap-like ulcers which goes along the direction of the esophagus with thin moss. G. A huge ulcer in the distal esophagus with clean bottom and even edges. H. Esophagus with huge ulcers, nearly 1/4 of the entire esophagus is occupied, part of the ulcer is covered with moss and clean.

Figure 2

Characteristic changes in pathology in esophageal mucosal epithelial tissues from AID patients with giant EUs (HE 10×10). A. Infiltration of eosinophils under the squamous epithelium in esophageal mucosal epithelial tissue. B. Infiltration of inflammatory cells under mucosal with partial epithelial shedding. C. Epithelial infiltration of inflammatory cells with formation of the ulcers. D. Large area necrosis and inflammatory cells infiltration in esophageal mucosa. E. Squamous is infiltrated with inflammatory cells. F. Infiltration of submucosal inflammatory cells and obvious edema.

Figure 3

RT-PCR of HIV pol gene, HSV and CMV specific genes for esophageal lesion biopsy specimens. HIV pol gene fragment size is 1316 bp, CMV and HSV gene fragments are 224 bp and 241 bp, respectively. M is DNA marker DL 2000, lane 1-16 are samples from the esophageal ulcer biopsy tissues in AIDS patients, P is the positive control of HIV, HSV and CMV, N is negative control.