Faecal tumour necrosis factor-alpha in individuals with HIV-related diarrhoea.
OBJECTIVE
HIV-related gastrointestinal infection is associated with diarrhoea, weight loss, mucosal inflammation and increased intestinal permeability. As tumour necrosis factor (TNF)-alpha may mediate these features this cytokine was measured in the faeces of HIV-seropositive individuals with diarrhoea to assess its role in the pathogenesis of HIV-related gastrointestinal disease and the association with specific intestinal pathogens.


METHODS
Prospective study.


METHODS
Two hundred and four HIV-seropositive individuals provided stool samples that were analysed for faecal TNF-alpha (FTNF-alpha) using a standard sandwich enzyme-linked immunosorbent assay.


RESULTS
Stool from patients with bacterial, cytomegalovirus (CMV) and microsporidial diarrhoea had significantly elevated FTNF-alpha compared with those who had pathogen-negative diarrhoea (P < 0.05). FTNF-alpha was not raised in cryptosporidiosis, pathogen-negative or solid stool. In subjects with diarrhoea of more than 2 weeks duration and three stool samples negative for enteric pathogens, FTNF-alpha greater than 15 U/ml has a sensitivity of 88% and a specificity of 66% for the diagnosis of diarrhoea-related CMV enteritis.


CONCLUSIONS
TNF-alpha production may have a role in the pathogenesis of bacterial, microsporidial and CMV-related diarrhoea in HIV-seropositive individuals. Thus, anti-TNF-alpha agents may have a therapeutic role in the management of these conditions. FTNF-alpha greater than 15 U/ml in apparently pathogen-negative diarrhoea may suggest endoscopic gastrointestinal biopsy to diagnose CMV enteritis.
Sharpstone
D R
DR
Department of HIV/Genitourinary Medicine, Chelsea and Westminster Hospital, London, UK.
Rowbottom
A W
AW
Nelson
M R
MR
Lepper
M W
MW
Gazzard
B G
BG
D017088:AIDS-Related Opportunistic Infections / Q000378:metabolism* / Q000503:physiopathology; D003967:Diarrhea / Q000209:etiology / Q000378:metabolism*; D005243:Feces; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D014409:Tumor Necrosis Factor-alpha