Tracheo-esophageal fistula in highly active antiretroviral therapy patient with AIDS

Abstract Introduction To the best of our knowledge, other than tuberculosis, tracheo-oesophageal fistula complicates oesophageal ulcers and has been rarely reported. Tracheo-oesophageal fistula, secondary to AIDS-defining infectious diseases and neoplasia, is regressing since the introduction of highly active antiretroviral therapy. It occurs as a complication of tuberculosis of the digestive tract and airways. Other infections causing deep oesophageal ulcers include cytomegalovirus, herpes simplex virus type 2 and HIV. Several studies have reported resistances of HIV1 to many antiretroviral drugs, making the occurrence of opportunistic gastrointestinal disease possible in patients treated with such drugs, particularly in the severely immunodepressed. The outcome is generally poor in the absence of treatment with an average survival rate of one to six weeks. This paper reports a case of tracheo-oesophageal fistula in a highly active antiretroviral therapy patient with AIDS. Case report We are reporting the case of a 43-year-old Cameroonian man, who was type 1 HIV-infected, classified CDC stage C3. He has been on treatment for about 10 years and on combination therapy for about six months. He presented with cough during swallowing, odynophagia and weight loss, complicating a medically treated tracheo-oesophageal fistula, whose outcome was poor. Conclusion Despite the various antiretroviral regimens available in developing countries, HIV-related digestive diseases remain a challenge with poor prognosis due to other limited therapeutic options. The diagnosis of tracheo-oesophageal fistula should be considered in the context of persistent cough during swallowing in patients with AIDS.