Characterization of intestinal disease associated with human immunodeficiency virus infection and response to antiretroviral therapy.
Combination antiretroviral therapies suppress human immunodeficiency virus (HIV) in peripheral blood, but the effect in gastrointestinal mucosa is uncertain. The occurrence of pathogen-negative diarrhea led to speculation that local HIV infection is etiologic. Mucosal cellular reservoirs for HIV were documented by use of several techniques. Correlations were found among gastrointestinal symptoms, histopathologic findings, cytokine expression, lymphoid apoptosis, and HIV RNA and protein expression in rectal mucosa. Disproportionate depletion of mucosal CD4+ lymphocytes also was found. The short-term effects of antiretroviral therapies were examined to test the hypothesis that these changes are directly related to mucosal HIV infection. Therapy was associated with decreased symptoms, with comparable drops in peripheral blood and mucosal HIV RNA contents, and by increases in blood and mucosal CD4+ lymphocyte contents. In addition, the number of apoptotic cells also declined during therapy. These results suggest that HIV plays a direct role in producing intestinal dysfunction.
Kotler
D P
DP
Gastrointestinal Division, Department of Medicine, St. Luke's- Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY 10025, USA. dpkotler@aol.com
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D017209:Apoptosis; D015496:CD4-Positive T-Lymphocytes / Q000821:virology; D003967:Diarrhea / Q000821:virology; D005759:Gastroenteritis / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000188:drug therapy; D007413:Intestinal Mucosa / Q000821:virology*; D011446:Prospective Studies
D019380:Anti-HIV Agents