ENTEROPATHY IN ZAMBIANS WITH HIV-RELATED DIARRHEA - REGRESSION MODELING OF POTENTIAL DETERMINANTS OF MUCOSAL DAMAGE

Background-AIDS is characterised by small intestinal mucosal damage, b ut its aetiopathogenesis is poorly understood. Enteric infections in A frica differ from those in northern countries, where protozoan infecti ons have been associated with severe enteropathy in AIDS patients. Aim s T-characterise enteropathy in Zambian AIDS patients compared with lo cal controls, and to assess relative contributions of enteric infectio n, nutritional impairment, and immune dysfunction. Methods-Computer ai ded mucosal morphometry of small intestinal biopsy specimens from 56 H IV infected Zambians with persistent diarrhoea and 26 diarrhoea free c ontrols, followed by regression modelling. Results-Patients with HIV r elated diarrhoea had reduced villous height and increased crypt depth compared with controls. There was no difference between HIV positive a nd negative controls. In regression models applied to AIDS mucosal mea surements, villous height and crypt depth were related to nutritional parameters and to serum soluble tumour necrosis factor receptor p55 co ncentration. Crypt depth was also related to lamina propria plasma cel l count. Intestinal infection was found in 79%, which consisted predom inantly of microsporidia in 34%, Isospora belli in 24%, and Cryptospor idium parvum in 21%, but detection of these enteropathogens was not re lated to severity of enteropathy. Conclusions-Nutritional and immune d isturbances were associated with enteropathy, accounting for over one third of the variation in mucosal morphometric parameters.