WEIGHT-LOSS, THE GUT AND THE INFLAMMATORY RESPONSE IN AIDS PATIENTS

The objective of this study was to test the hypothesis that the integr ity of the large bowel wall in AIDS patients is compromised in a manne r that favours the chronic translocation of bacteria and/or products o f bacterial metabolism into the bloodstream, When such translocation o ccurs, it induces a characteristic stress/inflammatory response in the body, Urinary butyrate, a unique product of colonic microbial metabol ism, was used to assess gut wall permeability, Excretion of the pro-in flammatory cytokine IL-6 in the urine was used as a marker for the str ess/inflammatory response, Four groups of subjects were studied, contr ols (n = 12), HIV+ (n = 35) and AIDS patients with (n = 14) and withou t (n = 17) weight loss. Results: measurable amounts of interleukin 6 ( IL-6) and butyrate were found in the urine of all subjects, There were no significant differences in IL-6 excretion between the controls (0. 68 +/- 0.64 pg/ml), asymptomatic HIV+ subjects (0.59 +/- 0.37 pg/ml) a nd AIDS patients without weight loss (1.18 +/- 0.33 pg/ml) but IL-6 le vels were significantly higher in the AIDS group with weight loss (4.0 2 +/- 1.26 pg/ml, P < 0.05), A similar pattern of results was found wi th interleukin 1 receptor antagonist (IL-1ra), Like IL-6 and (IL-1ra), urinary butyrate levels were increased in the AIDS patients with weig ht loss (2.83 +/- 0.67 mu mol/l) relative to the controls (1.31 +/- 0. 13 mu mol/l, P < 0.05), with the HIV+ patients (1.65 +/- 0.18 mu mol/l ) and AIDS patients without weight loss (1.90 +/- 0.22 mu mol/l) falli ng in between. The data are consistent with a low, but chronic rate of bacteria and/or bacterial products seeping across a compromised colon ic wall causing a chronic low stress response in AIDS patients. (C) 19 97 Academic Press Limited.