INTESTINAL PERMEABILITY IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: The etiology of acquired immunodeficiency syndrome (AIDS) e nteropathy is unknown. This condition has been associated with malabso rption and villous atrophy. Other disorders with similar findings, inc luding celiac disease, are characterized by altered intestinal permeab ility. Our objective was to confirm (or reject) our hypothesis that pr ocesses that cause increased permeability may occur in patients with A IDS, and thus be a cause of idiopathic diarrhea. Methods: A lactulose- mannitol differential intestinal permeability test was performed in he althy controls, asymptomatic human immunodeficiency virus (HIV)-positi ve patients, and AIDS patients with and without diarrhea. Results: Asy mptomatic HIV-positive patients lactulose and mannitol recoveries were no different than healthy control patients. AIDS patients without dia rrhea had lactulose recovery similar to healthy controls and decreased mannitol recoveries; their mean lactulose:mannitol ratio was no diffe rent from that of controls, and less than that of AIDS patients with d iarrhea. AIDS patients with diarrhea had increased lactulose recovery and decreased mannitol recovery; their mean lactulose:mannitol ratio w as significantly greater than the ratios in all the other groups. Conc lusions: Patients with AIDS and diarrhea have altered intestinal perme ability. The decreased absorption of mannitol suggests that the functi onal absorptive surface of the intestine decreases as HIV disease prog resses.