FECAL ALPHA(1) ANTITRYPSIN AS A MARKER OF GASTROINTESTINAL-DISEASE INHIV ANTIBODY-POSITIVE INDIVIDUALS

Hypoalbuminaemia and diarrhoea are common complications of HIV infecti on and substantial causes of morbidity, but the specific intestinal pa thologies that cause enteric protein loss have not been clearly define d. Two hundred and twenty stool samples from patients with a variety o f HIV related conditions were analysed for faecal alpha(1) antitrypsin . Patients with intestinal Kaposi's sarcoma had a significantly raised faecal alpha(1) antitrypsin value and hypoalbuminaemia. A faecal alph a(1) antitrypsin value of greater than 0.3 mg/g wet stool has a sensit ivity of 94% and a specificity of 76% for the diagnosis of intestinal Kaposi's sarcoma in HIV positive individuals. Patients with cytomegalo virus and bacterial enteritis had raised faecal alpha(1) antitrypsin v alues but levels were normal for all other intestinal pathologies comp ared with pathogen negative stool. The combination of faecal alpha(1) antitrypsin concentration greater than 0.2 mg/g, a negative stool cult ure for enteric bacteria, and the absence of palatal Kaposi's sarcoma has a sensitivity of 55% and specificity of 88% for the diagnosis of e nteric cytomegalovirus infection.