The advent of HAART has dramatically changed the progression of HIV disease. With the addition of protease inhibitors (PI) in 1997, certain disorders of the gastrointestinal (UGI) tract associated with advanced HIV disease (candida, wasting syndrome, AIDS-related diarrhea) appear to be much less common. We reviewed our experience with upper endoscopy in HIV patients since 1997 to determine: 1) the primary indications for upper GI procedures 2) the diagnostic and therapeutic yield of upper GI endoscopy 3) if patients on HAART had less HIV-related findings than those not on antiretroviral therapy. Methods: All patients, known to be HIV-positive, who had an UGI endoscopic procedure performed between 01/97 to 09/99 were identified through a computerized database. Data collected included: medications, CD4 count, comorbid diseases, indication for procedure, endoscopic and pathological diagnosis and therapy initiated. Results: 127 upper endoscopic procedures were performed. The mean CD4 count was 325 (range 0-900) cells/μl and 54% of the patients were on HAART. The most common indications for the procedures were pain (33%), dysphagia (22%), bleeding (22%) and diarrhea (17%). In endoscopies performed in patients presenting with pain, 43% were normal, 29% had esophagitis (19% candida-related) and 19% had either gastritis or gastric erosions. In those presenting with dysphagia, esophagitis was found in 66% (reflux-52%, candida-14%), 19% were normal and 7.5% had esophageal ulcers. In those with diarrhea, 57% had normal upper endoscopies and histology. An etiology of diarrhea was found in 19% (bacillary angiomatosis-2, subtotal villous atrophy-1, cryptosporidiosis-1). The highest yield of positive endoscopic results were seen in bleeding patients where 96% of patients had an etiology of bleeding discovered (esophageal or gastric varices-75%). Overall, 22% of patients had HIV-specific UGI endoscopic findings. Of these significantly more were found in patients not on antiretroviral therapy (14%) than those on HAART (7.8%). Conclusions: Since the initiation of HAART, the most common indications for upper endoscopy in HIV patients are abdominal pain, dysphagia, bleeding and diarrhea. Endoscopies performed on those patients presenting with UGI bleeding have the highest diagnostic yield and those presenting with pain the lowest. HIV-specific diagnosis are found more commonly in those HIV patients not taking HAART.