       Document 0663
 DOCN  M9620663
 TI    Presumptive clinical criteria versus endoscopy in the diagnosis of
       Candida esophagitis at various HIV-1 disease stages.
 DT    9602
 AU    Antinori A; Antinori A; Ammassari A; Masetti R; De Luca A; Murri R;
       Tamburrini E; Magistrelli P; Department of Infectious Diseases, Catholic
       University, Rome,; Italy.
 SO    Endoscopy. 1995 Jun;27(5):371-6. Unique Identifier : AIDSLINE
       MED/96026936
 AB    BACKGROUND AND STUDY AIMS: The presumptive diagnosis of Candida
       esophagitis has been included in the Centers for Disease Control (CDC)
       case definition for full-blown AIDS since 1987. Endoscopic examination
       should be reserved for patients showing symptoms despite treatment. The
       purpose of this study was to assess the degree of diagnostic accuracy of
       the CDC presumptive clinical criteria and to determine the usefulness of
       upper digestive endoscopy in the diagnosis of Candida esophagitis in
       patients infected with HIV-1, with and without a previous AIDS-defining
       event. PATIENTS AND METHODS: A total of 144 HIV-1 infected patients who
       had undergone an upper digestive endoscopy were studied retrospectively.
       To determine the risk and the predictive value of the clinical markers,
       only the 84 patients without prior antimycotic therapy were included.
       RESULTS: Of the 84 patients without previous treatment, 34 (41%) had a
       history of an AIDS-defining illness. Candida esophagitis was found on
       endoscopy in 11 of the AIDS and 28 of the non-AIDS cases. Oral thrush,
       either alone (relative risk [R.R.] 9.4; 95% C.I. 2.4-36.4; p < 0.01;
       positive predictive value [PPV] 82%) or in combination with esophageal
       symptoms (R.R. 7.4; 95% C.I. 2.5-21.9; p < 0.01; PPV 89%), was a
       reliable marker of Candida esophagitis only in patients with a previous
       AIDS-defining event. The diagnostic value of the CDC presumptive pattern
       was confirmed by a multivariate analysis after controlling for the CD4
       cell count (R.R. 9.3; 95% C.I. 2.3-25.3; p < 0.01). On the other hand,
       in HIV-1 positive patients without a previous AIDS-defining event, the
       diagnostic accuracy of oral candidiasis, either alone (R.R. 1.4; 95%
       C.I. 0.8-2.4; p n.s.; PPV 64%) or in combination with esophageal
       symptoms (R.R. 1.1; 95% C.I. 0.7-1.8; p n.s.; PPV 60%), was too low to
       allow a reliable diagnosis of Candida esophagitis. CONCLUSIONS: A
       presumptive diagnosis of Candida esophagitis on the basis of the CDC
       clinical criteria is a valid diagnostic method only in HIV-1 infected
       patients with a previous diagnosis of full-blown AIDS. Upper digestive
       endoscopy should be performed in symptomatic patients with no history of
       an AIDS-defining illness, especially if the diagnosis of esophageal
       candidiasis is important for surveillance purposes.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/MICROBIOLOGY
       Candidiasis/*COMPLICATIONS/*DIAGNOSIS
       Esophagitis/*COMPLICATIONS/*DIAGNOSIS/MICROBIOLOGY  Female  Human  HIV
       Infections/*COMPLICATIONS  *HIV-1  Male  Middle Age  Retrospective
       Studies  Sensitivity and Specificity  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

