AIDS - Contraindications

Dig Dis 1996 Jul-Aug;14(4):228-44

Gastrointestinal endoscopy in high-risk patients.

Cappell MS

Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.

In America more than 100,000 high-risk patients/year have conditions normally evaluated by gastrointestinal endoscopy. This review analyzes the safety and efficacy of gastrointestinal endoscopy in high-risk patients. Endoscopy during pregnancy raises the unique issue of fetal safety. The safety of esophagogastroduodenoscopy (EGD) during pregnancy has been examined in a case-controlled study of 83 patients, a mailed survey of 73 patients, and case reports. The safety of sigmoidoscopy during pregnancy has been examined in a case-controlled study of 45 patients, a mailed survey of 26 patients, and case reports. These studies suggest that EGD and sigmoidoscopy are not contraindicated during pregnancy. For example, EGD should be performed for significant upper gastrointestinal bleeding. The safety of colonoscopy during pregnancy is inadequately analyzed. In a study of 34 EGDs performed within 3 weeks of myocardial infarction, no endoscopic complications occurred in 26 clinically stable patients with uncomplicated myocardial infarction. However, 3 major endoscopic complications occurred in 8 clinically unstable patients. In a study of 9 sigmoidoscopies within 3 weeks of myocardial infarction, no sigmoidoscopic complications occurred in 7 clinically stable patients. Several studies have shown that EGD, sigmoidoscopy, or colonoscopy is safe in patients with advanced HIV infection. AIDS patients should generally be endoscoped with the same aggressiveness as other patients. However, endoscopy may be unwise in any terminal patient. No complication occurred in 60 patients undergoing EGD within 3 weeks of esophageal, gastric, or duodenal surgery. One minor complication occurred in 36 patients undergoing sigmoidoscopy within 3 weeks of colonic surgery. These results suggest that EGD or sigmoidoscopy is not contraindicated within 3 weeks of gastrointestinal surgery. No complications occurred in 53 chronic obstructive pulmonary disease patients undergoing EGD. EGD appears to be safe in chronic obstructive pulmonary disease patients without severe hypoxemia or acute bronchospasm. Emergency EGD can be performed in patients with severe hypoxemia after endotracheal intubation.

Publication Types:

• Review
• Review, tutorial

PMID: 8843979, UI: 97000949

J Am Acad Dermatol 1994 Aug;31(2 Pt 2):372-5

The use of methotrexate for treatment of psoriasis in patients with HIV infection.

Maurer TA, Zackheim HS, Tuffanelli L, Berger TG

Department of Dermatology, University of San Francisco, CA.

The use of methotrexate (MTX) has been contraindicated for treatment of severe psoriasis in HIV infection on the basis of six previously reported cases in which MTX appeared to potentiate opportunistic infections and accelerate HIV disease. We describe three HIV-infected patients who were given MTX for severe psoriatic arthritis. In two patients opportunistic infections did not develop. On the basis of survival data, it is not clear that use of MTX adversely affected the natural course of their HIV disease.

Publication Types:

• Review
• Review, tutorial

PMID: 8034807, UI: 94308359

Fortschr Med 1994 Mar 10;112(7):87-91

[Adjuvant corticoid administration within the scope of HIV disease. Indications in wasting syndrome and other diseases within the scope of AIDS].

Jager H

KIS-Kuratorium fur Immunschwache, Munchen.

While at the start of the AIDS epidemic, corticosteroids were considered to be contraindicated, about 10 indications have since been identified for the specific use of glucocorticoids in HIV infection. Some of these indications have already been confirmed in controlled scientific studies, for example, pneumocystis carinii pneumonia or HIV-induced high-grade non-Hodgkin's lymphoma. In the case of other indications, for example, cerebral toxoplasmosis or certain forms of the wasting syndrome, clinical observational studies and, in particular, empirical data provided by large groups working on AIDS, are available. The use of corticoids for such other indications as pulmonary involvement in the case of Kaposi's sarcoma, or thrombopenia in HIV patients, is still experimental. To date, the initially feared high rate of side effects due to the theoretically possible impairment of immunological function, has not been observed. The effect of the corticosteroids appears to be concentrated more in their anti-inflammatory action than in substitution in the event of adrenal insufficiency. The carefully considered and selective use of corticosteroids can both improve the quality of life and lengthen the life expectancy of many HIV victims.

Publication Types:

• Review
• Review, tutorial