DIARRHEA IN HIV-INFECTED PATIENTS - NO EVIDENCE OF CYTOKINE-MEDIATED INFLAMMATION IN JEJUNAL MUCOSA

Objective: To determine whether a mucosal cytokine-mediated inflammato ry response is involved in cryptosporidial or microsporidial diarrhoea , as well as in diarrhoea of unknown origin in HIV-infected patients. Design: Prospective study. Methods: Jejunal biopsies were obtained fro m HIV-infected patients with diarrhoea. Controls were HIV-infected and HIV-seronegative patients without diarrhoea. Two biopsies were homoge nized immediately and two other biopsies were first cultured for 20 h. Cytokines [tumour necrosis factor (TNF), interleukin (IL)-1 beta, IL- 6, IL-8, IL-10], soluble TNF receptors (sTNFR) p55 and p75, and solubl e IL-2 receptor (sIL-2R) were assessed in the homogenates and in the s upernatants by sandwich enzyme-linked immunosorbent or enzyme-linked b inding assays. The cytokine receptors were also measured in serum. Res ults: Six HIV-infected patients with cryptosporidiosis, six with micro sporidiosis, seven with diarrhoea of unknown origin, seven without dia rrhoea, and seven HIV-seronegative patients were eligible. Four patien ts were excluded because of the presence of other pathogens. No cytoki nes were detected in immediately homogenized jejunal tissue. Following culture, IL-6 and IL-8 levels were higher in HIV-infected patients wi th diarrhoea of unknown origin than in HIV-seronegative controls witho ut diarrhoea, although this was not statistically significant. No diff erences in serum or post-culture supernatant sTNFR p55 and p75 levels existed between the HIV-infected patients with or without diarrhoea. s TNFR, IL-1 beta, IL-10 and the sIL-2R were only detected in low amount s or not at all, acid were equally distributed among all patient group s. Conclusions: This study indicates that mucosal cytokine-mediated in flammatory responses do not play an important role in the pathogenesis of different types of diarrhoea in HIV-infected patients. These resul ts do not support the use of immunomodulatory therapy in these patient s.