Changes in small intestinal structure and function in HIV-infected patients with chronic diarrhoea

Human immunodeficiency virus (HIV) is often combined with unexplainable dia rrhoea and weight loss. This stun. was designed to see if changes in the in testinal mucosal structure could explain the malabsorption found in HIV-inf ected patients with diarrhoea, Twenty acquired immunodeficiency system (AID S) patients, 19 men and 1 woman, CD4 < 0.01, with severe weight loss and wi th non-infectious chronic diarrhoea, were evaluated using a ne iv intestina l function test (D-xylose breath test). Fifteen of the subjects mere examin ed with an upper intestinal endoscopy with biopsy specimens taken from the duodenal mucosa, The function test showed that the D-xylose uptake a as mar kedly decreased to the same extent as for patients with coeliac disease (br eath index AIDS patients 9.4 (4.3-14.4), coeliac patients 15.6 (7.6-23.6), reference level 2.5 (2.4-2.9), urine excretion AIDS patients 20% (13-26), c oeliac patients 22% (14-24), reference level 37% (32-42)), The severe malab sorption could not be explained by the slight mucosal changes occasionally seen by light microscopy with small mucosal inflammation and almost normal villi, However, electron microscopy showed enterocytes with signs of hypofu nction and degeneration correlating better to the intestinal malabsorption found in patients with advanced HIV infection and chronic diarrhoea.