Features of Gastrointestinal Bleeding in Patients with HIV-Related Infections

Gastrointestinal hemorrhage is about 1.3 times more common in HIV-infected patients than in HIV-negative ones. At the same time the structural and etiological causes of hemorrhage in HIV differ in many ways from the main population which is undoubtedly due to the use of modern antiretroviral therapy, opportunistic infections and comorbidities. Aim: to study the factors which are aggravating the course and influencing the structure of gastrointestinal bleeding in patients with HIV infection on the background of immunosuppressive disorders in comparison with HIV-negative patients. Material and methods. To achieve this goal a multicenter retrospective cohort study of three groups of patients with gastrointestinal hemorrhage was conducted. Five hundred patients participated in the study: n = 111 — the main group (42 in Group 1 — HIV+, CD4+ > 200; 69 in Group 2 — HIV+, CD4+ < 200); n = 389 — in the control group (Group 3 — HIV-negative status). Results. It was found that the comparison groups differ in age, the presence of previous hematological pathology (anemia, thrombocytopenia) as well as the sources of gastrointestinal bleeding. It can be noted that in all comparison groups endoscopic hemostasis methods were effective in about half of the cases (50.0 %, 42.0 % and 49.7 %), in the remaining findings hemostatic therapy was effective and sufficient (47.6 %, 33.3 % and 39.7 %). Surgical treatment was much more often required (statistically significant) in the group of patients with low immune status (29.0 %), and the need for it was associated with “rare sources” of bleeding: tuberculous intestinal ulcers, cytomegalovirus intestinal ulcers and decomposing Kaposi’s sarcoma of various parts of the digestive tract. The overall survival rate of HIV-infected patients with low immune status and gastrointestinal bleeding was statistically lower than in HIV-negative patients or patients with satisfactory immune status. Conclusion. Gastrointestinal bleeding in HIV-positive patients has a number of significant features, that directly affect severity of blood loss, treatment methods and patient survival.