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Changes in small intestinal structure and function in HIV-infected patients with chronic diarrhoea
1Department of Medicine and Pathology, Ullevaal University Hospital, Oslo, Norway.
Scandinavian Journal of Infectious Diseases
|March 5, 1999
Summary
Human immunodeficiency virus (HIV) infection causes severe malabsorption in patients with chronic diarrhea. Electron microscopy revealed enterocyte damage, explaining the intestinal dysfunction despite minimal mucosal changes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Cell Biology
Background:
- Human immunodeficiency virus (HIV) infection is frequently associated with unexplained diarrhea and weight loss.
- Malabsorption is a common complication in advanced HIV infection, but its underlying mechanisms remain incompletely understood.
- Investigating intestinal mucosal changes is crucial for explaining malabsorption in HIV-infected individuals.
Purpose of the Study:
- To investigate the relationship between intestinal mucosal structure and malabsorption in HIV-infected patients with chronic diarrhea.
- To evaluate intestinal function using the D-xylose breath test and correlate findings with mucosal histology.
- To elucidate the cellular basis of malabsorption in advanced HIV infection.
Main Methods:
- Twenty patients with acquired immunodeficiency syndrome (AIDS), severe weight loss, and chronic diarrhea underwent D-xylose breath testing.
- Fifteen patients had upper intestinal endoscopy with duodenal biopsies for light and electron microscopy.
- Intestinal function was assessed by D-xylose uptake and excretion, compared to coeliac disease patients and reference levels.
Main Results:
- D-xylose uptake was significantly decreased in AIDS patients, comparable to coeliac disease patients, indicating severe malabsorption.
- Light microscopy showed minimal mucosal inflammation and near-normal villi, insufficient to explain the observed malabsorption.
- Electron microscopy revealed enterocyte hypofunction and degeneration, correlating with intestinal malabsorption in advanced HIV infection.
Conclusions:
- Severe malabsorption in HIV-infected patients with chronic diarrhea is primarily due to enterocyte dysfunction rather than significant mucosal architectural changes.
- Electron microscopy is essential for identifying subtle cellular alterations that explain malabsorption in advanced HIV.
- These findings highlight the impact of HIV on intestinal cell function, contributing to gastrointestinal complications.
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