Objective: To assess the contribution of protein-losing enteropathy to
AIDS-associated hypoalbuminemia. Design: Prospective assessment of pa
tients with AIDS. Setting. An urban county hospital (Los Angeles & Uni
versity of Southern California Medical Center. USA). Patients: Four gr
oups of patients with AIDS were studied: (1) patients with normal seru
m albumin (greater-than-or-equal-to 3.9 g/dl) and normal bowel habits;
(2) patients with normal serum albumin and diarrhea (greater-than-or-
equal-to four loose or watery stools per day for greater-than-or-equal
-to 2 weeks); (3) patients with hypoalbuminemia (less-than-or-equal-to
3.0 g/dl) and normal bowel habits; and (4) patients with hypoalbumine
mia and diarrhea. Main outcome measure: Fecal alpha1-antitrypsin conce
ntration was used as a measure of protein loss in the gut. Results: Pa
tients with hypoalbuminemia had a significantly higher mean fecal alph
a1-antitrypsin concentration than those with normal albumin (10.8 +/-
3.0 mg/g dry stool versus 2.4 +/- 0.4 mg/g dry stool; P less-than-or-e
qual-to 0.001). Although mean fecal alpha1-antitrypsin concentrations
were similar in patients with and without diarrhea in the normal album
in group, patients with hypoalbuminemia and diarrhea had signficantly
higher levels of fecal alpha1-antitrypsin than those with hypoalbumine
mia and normal bowel habits (17.3 +/- 5.8 mg/g dry stool versus 4.6 +/
- 1.0 mg/g dry stool; P = 0.009). Twelve out of 36 (33%) patients with
normal albumin had elevation of fecal alpha1-antitrypsin compared wit
h 33 (70%) of 47 patients with hypoalbuminemia (P less-than-or-equal-t
o 0.001). Linear regression analysis showed a significant negative cor
relation between serum albumin and fecal alpha1-antitrypsin concentrat
ion (r = -0.38; P less-than-or-equal-to 0.001). Fecal alpha1-antitryps
in was significantly higher in patients with mucosal disease visualize
d at upper endoscopy or flexible sigmoidoscopy than in those without g
ross abnormalities (13.5 +/- 5.8 mg/g dry stool versus 2.4 +/- 0.7 mg/
g dry stool; P = 0.005). Conclusion: Protein-losing enteropathy is com
mon in patients with AIDS and may contribute to the development of hyp
oalbuminemia in these patients.