Intestinal inflammation, ileal structure and function in HIV.
OBJECTIVE
This study examines small intestinal absorption-permeability, intestinal inflammation and ileal structure and function in HIV-positive male homosexuals.


METHODS
Thirty HIV-seropositive male homosexuals at various stages of disease underwent intestinal absorption permeability and 111indium leukocyte studies (for quantification of intestinal inflammation). Twenty-six men with AIDS had a dual radioisotopic ileal function test (whole body retention of tauro 23-[75Se]-selena 25-homocholic acid and 58cobalt-labelled cyanocobalamine), and 17 underwent ileocolonoscopy with terminal ileal biopsy.


RESULTS
Well, HIV-infected, subjects had normal intestinal absorption-permeability, but both functions were impaired upon the development of AIDS. The median faecal excretion of 111indium in well patients (0.66%) did not differ significantly (P > 0.5) from controls (0.46%), but subjects with AIDS who were well or who had diarrhoea had significant (P < 0.005) intestinal inflammation (1.33% and 2.18%, respectively). The median 7-day retention of tauro 23-[75Se]-selena 25-homocholic acid in well patients with AIDS (38.9%) did not differ significantly (P > 0.2) from controls (39.3%), whereas the absorption of 58cobalt-labelled cyanocobalamine was significantly (P < 0.05) lower than controls (32.1% and 59.4%). Patients with AIDS-diarrhoea had significant (P < 0.001) malabsorption of both the bile acid (7.7%) and vitamin B12 (8.9%) which was more severe than in Crohn's ileitis (14.2% and 30.3%, respectively). Morphometric analyses of ileal biopsies were unremarkable in AIDS.


CONCLUSIONS
These studies demonstrate a low-grade enteropathy in patients with AIDS, severe ileal malabsorption in patients with AIDS diarrhoea and relatively minor ileal morphologic changes. Malabsorption of bile acids may play a pathogenic role in patients with AIDS and diarrhoea.
Department of Clinical Biochemistry, King's College School of Medicine and Dentistry, London, UK.
I
I
Bjarnason
D R
DR
Sharpstone
N
N
Francis
A
A
Marker
C
C
Taylor
M
M
Barrett
A
A
Macpherson
C
C
Baldwin
I S
IS
Menzies
R C
RC
Crane
T
T
Smith
A
A
Pozniak
B G
BG
Gazzard
D000163:Acquired Immunodeficiency Syndrome / Q000473:pathology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D003424:Crohn Disease / Q000473:pathology; D003967:Diarrhea / Q000473:pathology; D006679:HIV Seropositivity / Q000473:pathology*; D006801:Humans; D007082:Ileum / Q000473:pathology*; D015212:Inflammatory Bowel Diseases / Q000473:pathology*; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D014805:Vitamin B 12 / Q000378:metabolism
D014805:Vitamin B 12