Aim: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects.
Material and methods: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains.
Results: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material.
Conclusion: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.