The prevalence and severity of intestinal disaccharidase deficiency in human immunodeficiency virus-infected subjects

Background: Gasuointestinal symptoms are distressing features of human immu nodeficiency virus (HN) infection, and management is often empirical, inclu ding withdrawal of dietary lactose. We assessed the prevalence and severity of intestinal disaccharidase deficiency in vitro and in vivo. Methods: Fif ty-four HIV-seropositive patients (19 HIV well +/- mild diarrhoea, 7 acquir ed immunodeficiency syndrome (AIDS) well, and 28 AIDS with diarrhoea) were studied with a combined non-invasive absorption-permeability-disaccharidase test that enables quantitative assessment of the rate of intestinal hydrol ysis of lactose, sucrose, and palatinose. Thirty patients had jejunal biops y specimens suitable for histomorphometric assessment, and 36 had in vitro disaccharidase activity measurement. Results: Patients with HIV (with mild diarrhoea) and AIDS (with and without severe diarrhoea) had frequent but mi ld histomorphometric changes in jejunal specimens. This was associated with frequent (21%-100%) and often severe in vitro jejunal disaccharidase defic iency. In vivo hydrolysis of lactose, sucrose, and palatinose was impaired in 25%-75% of patients, apart from HIV well patients, who were normal. The prevalence of the in vivo lactase and sucrase deficiency was significantly (P < 0.006) lower than in vitro and severe in about 30%. Conclusions: Intes tinal disaccharidase deficiency is common both in vitro and in vivo in HIV- seropositive patients but sufficiently severe to consider lactose withdrawa l only in about a quarter of the patients with AIDS and diarrhoea.