Small intestinal structure and function in patients infected with human immunodeficiency virus (HIV): evidence for HIV-induced enteropathy.
OBJECTIVE
To determine small intestinal mucosal structure and function in patients with human immunodeficiency virus (HIV) infection.


METHODS
Prospective, consecutive sample study.


METHODS
Referral-based medical clinics at a municipal and a university medical center.


METHODS
Forty-five HIV-infected patients (44 men, 1 woman) with gastrointestinal complaints.


METHODS
All patients had esophagogastroduodenoscopy. Distal duodenal biopsy samples were examined morphometrically and by quantitative enzyme histochemical techniques. Immunohistologic studies were done to determine whether HIV antigen p24 was present. Biopsy and stool samples were examined for enteric pathogens and patients were evaluated for malabsorption.


RESULTS
Malabsorption was common in HIV-infected patients. In 15 of 38 patients mononuclear cells infected with HIV were found in the mucosa. In 15 of 25 patients there was no detectable lactase (beta-glucosidase) activity in the duodenal brush border; when measurable, lactase (beta-glucosidase) activity was decreased (P less than 0.02). Alkaline phosphatase activity was normal. Crypt depth was greater (P less than 0.05), villous surface area was slightly smaller, and mitotic figures per crypt were not different in HIV-infected patients compared with controls. Patients without additional intestinal infection had a reduced number of mitotic figures per crypt (P less than 0.05) and normal crypt depth. The reduction in mitotic figures was most pronounced in patients with mucosal HIV antigen p24.


CONCLUSIONS
The HIV-infected patients with gastrointestinal symptoms show low-grade small bowel atrophy and a maturational defect in enterocytes, which may be caused exclusively by HIV. An additional intestinal infection can mask this mucosal atrophy.
Ullrich
R
R
Free University of Berlin, Federal Republic of Germany.
Zeitz
M
M
Heise
W
W
L'age
M
M
Höffken
G
G
Riecken
E O
EO
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D000328:Adult; D000469:Alkaline Phosphatase / Q000032:analysis; D005260:Female; D015488:HIV Antigens / Q000032:analysis; D016655:HIV Core Protein p24; D006651:Histocytochemistry; D006801:Humans; D007413:Intestinal Mucosa / Q000201:enzymology / Q000473:pathology; D007421:Intestine, Small / Q000382:microbiology / Q000473:pathology* / Q000503:physiopathology; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012191:Retroviridae Proteins / Q000032:analysis; D001616:beta-Galactosidase / Q000032:analysis
D015488:HIV Antigens; D016655:HIV Core Protein p24; D012191:Retroviridae Proteins; D000469:Alkaline Phosphatase; D001616:beta-Galactosidase