HIV感染症患者の下部消化管病変

Intestinal Lesions in Patients with HIV Infection

要旨　HIV感染症患者で頻度が高いCMV腸炎，アメーバ性大腸炎，肛門部尖圭コンジローマ，Kaposi肉腫，悪性リンパ腫について述べ，特にCMV腸炎，アメーバ性大腸炎についてはHIV陽性群の特徴について対照と比較検討した．HIV陽性CMV腸炎は8例全例が男性で，CD4陽性T細胞数は全例200/μl以下であった．HIV陽性群では男性，潰瘍性大腸炎様の内視鏡像を示す症例が有意に多く，穿孔例や血中antigenemia陽性率が高い傾向がみられた．HIV陽性アメーバ性大腸炎はCD4陽性T細胞数は9例中5例が200/μl未満，2例が500/μl未満，2例が500/μl以上であり，劇症例はすべて200/μl以下であった．アメーバ性大腸炎のHIV陽性群はHIV陰性群に比べて有意に男性同性愛者，劇症例，重症例が多かった．重症例が多い理由は免疫不全の関与が考えられた．

　We mention CMV（cytomegalovirus）enterocolitis, amebic colitis, anal condyloma acuminatum, intestinal Kaposi sarcoma and malignant lymphoma, which often develop in patients with HIV（human immunodeficiency virus）infection. Especially, the character of CMV enterocolitis and amebic colitis in patients with HIV infection was studied．All of CMV enterocolitis patients with HIV infection were males with severe immunodeficiency（CD4 cell＜200/μl）. In the CMV enterocolitis patients with HIV infection, the rate of males, intestinal perforation, detection of serum antigenemia and ulcerative colitis-like endoscopic findings were higher than those in the CMV enterocolitis patients without HIV infection. CD4 cell count in five amebic colitis patients with HIV infection was under 200/μl, that of two of them was under 500/μl and that of another two was over 500/μl. CD4 cell count of all fulminant amebic colitis patients with HIV infection was under 200/μl. The count in homosexual men and patients with severe colitis among amebic colitis patients with HIV infection, was significantly more than in those in amebic colitis patients without HIV infection. We think immunodeficiency had caused severe colitis.