INTESTINAL MALABSORPTION OF HIV-INFECTED CHILDREN - RELATIONSHIP TO DIARRHEA, FAILURE-TO-THRIVE, ENTERIC MICROORGANISMS AND IMMUNE IMPAIRMENT

Objective: To determine the features and the prevalence of intestinal- dysfunction in HIV-infected children and to investigate its relationsh ip to diarrhoea, growth failure, immune dysfunction and enteric pathog ens. Design: Case controlled, cross-sectional multicentre study. Setti ng: Children enrolled in tertiary care Italian centres for paediatric HIV infection from June 1990 to June 1992. Intestinal function tests a nd investigation for enteric viruses were performed in Naples. Patient s: Forty-seven children with symptomatic HIV infection, six of whom ha d diarrhoea. Fifty non-infected children with diarrhoea and 48 healthy children were enrolled as controls for enteric viruses positivity and intestinal tests. Methods: Intestinal function was investigated by me asuring fat, protein and carbohydrate absorption using the steatocrit method, and determining the faecal concentration alpha-1-antitrypsin a nd the d-xylose absorption, respectively. Microbiological studies incl uded investigation for classical and opportunistic pathogens and for e nteric viruses by electron microscopy in the stools of HIV-infected ch ildren. The presence of viruses in the stools of HIV-negative children was also investigated. Results: A high prevalence of intestinal-dysfu nction was detected in HIV-infected children; faecal fat loss was dete cted in 14 out of 47 (30%), carbohydrate malabsorption in 1 5 out of 4 7 (32%) and protein loss in eight out of 47 (17%) HIV-infected childre n. Mean values of xylose blood level and of steatocrit were significan tly different from those of healthy controls. Four children with diarr hoea were positive for Cryptosporidium. The prevalence of enteric viru ses was significantly increased in HIV-infected children (57%) compare d with healthy controls (17%). Intestinal-dysfunction was not associat ed with diarrhoea, poor growth, enteric agents or degree of immune dys function. Conclusions: Intestinal-dysfunction, consisting of fat, carb ohydrate and protein malabsorption, is a common feature of paediatric HIV infection. Although not clinically evident, it may contribute to f urther worsening of the disease.