The prevalence and severity of intestinal disaccharidase deficiency in human immunodeficiency virus-infected subjects.
BACKGROUND
Gastrointestinal symptoms are distressing features of human immunodeficiency virus (HIV) infection, and management is often empirical, including withdrawal of dietary lactose. We assessed the prevalence and severity of intestinal disaccharidase deficiency in vitro and in vivo.


METHODS
Fifty-four HIV-seropositive patients (19 HIV well +/- mild diarrhoea, 7 acquired immunodeficiency syndrome (AIDS) well, and 28 AIDS with diarrhoea) were studied with a combined non-invasive absorption-permeability-disaccharidase test that enables quantitative assessment of the rate of intestinal hydrolysis of lactose, sucrose, and palatinose. Thirty patients had jejunal biopsy specimens suitable for histomorphometric assessment, and 36 had in vitro disaccharidase activity measurement.


RESULTS
Patients with HIV (with mild diarrhoea) and AIDS (with and without severe diarrhoea) had frequent but mild histomorphometric changes in jejunal specimens. This was associated with frequent (21%-100%) and often severe in vitro jejunal disaccharidase deficiency. In vivo hydrolysis of lactose, sucrose, and palatinose was impaired in 25%-75% of patients, apart from HIV well patients, who were normal. The prevalence of the in vivo lactase and sucrase deficiency was significantly (P < 0.006) lower than in vitro and severe in about 30%.


CONCLUSIONS
Intestinal disaccharidase deficiency is common both in vitro and in vivo in HIV-seropositive patients but sufficiently severe to consider lactose withdrawal only in about a quarter of the patients with AIDS and diarrhoea.
Dept of Sexually Transmitted Disease. Chelsea & Westminster Hospital. London, UK.
C
C
Taylor
K
K
Hodgson
D
D
Sharpstone
G
G
Sigthorsson
M
M
Coutts
R
R
Sherwood
I
I
Menzies
B
B
Gazzard
I
I
Bjarnason
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001692:Biological Transport; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015897:Comorbidity; D004186:Disaccharidases / Q000172:deficiency* / Q000378:metabolism*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000201:enzymology / Q000473:pathology; D007579:Jejunal Diseases / Q000201:enzymology* / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D004186:Disaccharidases