Úlceras esofágicas como forma de apresentação da infecção aguda pelo vírus da imunodeficiência humana tipo 1(VIH-1)

 

S. Ferreira¹, I. Claro¹, I. P. Lage¹, P. Chaves², C. Nobre Leitão¹

 

Resumo

A infecção aguda pelo Vírus da Imunodeficiência Humana tipo 1 (VIH-1) pode ser sintomática. Entre 40 e 90% dos indivíduos infectados apresentam sintomas enquadráveis numa síndroma mononucleósica, inespecífica, o que torna o diagnóstico muito difícil e improvável nesta fase.

Os autores descrevem o caso clínico de um doente com síndroma febril e odinofagia, cuja investigação conduziu à detecção de infecção aguda pelo VIH-1. Salienta-se que o diagnóstico nesta fase apenas foi possível pela maior especificidade sintomática e aspectos endoscópicos observados. Discute-se ainda a relevância de se estabelecer o diagnóstico precocemente na história natural da doença.

 

Summary

Acute Human Immunodeficiency Virus type 1 infection (HIV-1) may be symptomatic. Between 40 and 90% of the patients experience nonspecific mononucleosis-like symptoms, making the diagnosis difficult and less probable at this time.

The authors describe a case of acute primary HIV-1 infection in a patient who presented with fever and odynophagia. Diagnosis at this stage was only possible because of the more specific nature of the symptoms developed as well as the endoscopic findings observed. The relevance of diagnosing the illness early in its natural history is also discussed.

 

 

Texto Completo disponível apenas em PDF

Full text only available in PDF format

 

 

Bibliografia

 

1. Kassutto S, Rosenberg E. Primary HIV type 1 infection. HIV/AIDS 2004; 38:1447-53.        [ Links ]

2. Gaines H, von Sydow M, Pehrson PO, Lundbegh P. Clinical picture of primary HIV infection presenting as glandular-fever-like illness. BMJ 1998; 297: 1363-8.

3. Rabeneck L, Boyko W, McLean D, McLeod W, Wong KK. Unusual esophageal ulcers containing enveloped viruslike particles in homosexual men. Gastroenterology 1986; 90: 1882-9.

4. Rabeneck L, Popovic M, Gartner S, McLean D, McLeod W, Read E, et al. Acute HIV infection presenting with painful swallowing and esophageal ulcers. JAMA 1990; 17: 2318-22.

5. Bartelsman J, Lange J, van Leeuwen R, van den Tweel J, Tytgat G. Acute Primary HIV-esophagitis. Endoscopy 1990; 22:184-5.

6. Ruiz-Laiglesia F, Torrubia-Perez C, Perez-Calvo J. Ulcerative esophagitis during primary HIV infection. Arch Intern Med 1996; 156:1115.

7. Kahn J, Walker B. Acute immunodeficiency virus type 1 infection. N Engl J Med 1998; 339: 33-9.

8. Ehrenpreis E, Bober D. Idiopatic ulcerations of the esophagus in HIV-infected patients: a review. International Journal of STD and AIDS 1996; 7: 77-81.

9. Hecht F, Busch M, Rawal B, Webb M, Rosenberg E, Swanson M, et al. Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS 2002; 16: 1119-29.

10. McMichael AJ, Callan M, Appay V, Hanke T, Ogg G, Rowland- Jones S. The dynamics of the cellular immune response to HIV infection: implications for vaccination. Philos Trans R Soc Lond B Biol Sci 2000; 355:1007-11.

11.Kotler D, Reka S, Orenstein J, Fox C. Chronic idiopathic esophageal ulceration in the Acquired Immunodeficiency Syndrome - Characterization and treatment with corticosteroids. J Clin Gastroenterol 1992; 15: 284-90.

12. Jacobson JM, Spritzler J, Fox L, Fahey JL, Jackson JB, Chernoff M, et al. Thalidomide for the treatment of esophageal aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Disease AIDS Clinical Trials Group. J Infect Dis. 1999;180: 61-7.

13. Alexander LN, Wilcox CM. A prospective trial of thalidomide for the treatment of HIV-associated idiopathic esophageal ulcers. AIDS Res Hum Retroviruses 1997;13: 301-4.

14. Pilcher D, Eron J, Vemazza L, Battegay M, Harr T, Yerly S. Sexual transmission during the incubation period of primary HIV infection. JAMA 2001; 286:1713-4.

15.Samet H, Freedberg A, Savetsky B, Sullivan M, Stein D. Understanding delay to medical care for HIV infection: the longterm non-presenter. AIDS 2001; 15:77-85.

16. Huang S, Lee H, Liu H, Lee N, Ko W. Acute human immunodefi ciency virus infection. J Microbiol Immunol Infect 2005; 38:65-8.

17. British HIV Association guidelines for the treatment of HIV disease with antiretroviral therapy. 2003. Available at: http://www.aidsmap.com/about/bhivagd.asp. Accessed 26 December 2003.

 

Correspondência:

Sara Ferreira

Instituto Português de Oncologia de Lisboa de Francisco

Gentil, E.P.E.

Serviço de Gastrenterologia

Fax: 217 229 855

e-mail: saragferreira@netcabo.pt

 

(1) Serviço de Gastrenterologia

(2) Serviço de Anatomia Patológica

Instituto Português de Oncologia de Lisboa de Francisco Gentil, E.P.E., Lisboa, Portugal.

 

Recebido para publicação: 03/10/2006

Aceite para publicação: 23/02/2007