Altered small-intestinal permeability associated with diarrhoea in human-immunodeficiency-virus-infected Caucasian and African subjects

Abstract

1. Small-intestine integrity in Caucasian and African patients infected with human immunodeficiency virus was determined by measuring the permeation across the mucosa of two sugars, lactulose and mannitol. 2. The sugars were assayed by h.p.l.c. and pulsed amperometric detection in 6 h urine samples. Stool microscopy for enteropathogens was performed in all patients. 3. The ratio of lactulose to mannitol recovered in urine was increased in Caucasian and African patients with advanced human immunodeficiency virus infection. Asymptomatic human-immunodeficiency-virus-infected subjects had a normal lactulose/mannitol ratio. African patients with diarrhoea showed a twofold reduction in mannitol excretion. Such a change in mannitol absorption was not detected in Caucasian patients and occurred regardless of the presence of enteropathogens. 4. Altered small-intestinal permeability is associated with symptomatic diarrhoea in human immunodeficiency virus infection in both Caucasian and African patients.

Enteropathies in the Developing World: Neglected Effects on Global Health

“…Importantly, of the permeability studies, none found any evidence of enteropathy in early HIV. 9,34,35,41 Taken together, although there are some enteropathic changes (crypt hyperplasia, cytokine dysregulation) in early HIV infection, the most important changes from the perspective of MT are predominantly seen in advanced disease.…”

“…33 Individuals with advanced disease developed a chronic, inflammatory enteropathy, frequently characterized by malabsorption and increased intestinal permeability. 34,35 However, before late-stage AIDS most HIV-infected individuals had fairly normal gut structure and function. 34,35 More recently, attention has refocused on the impact of HIV on the gut, following the observation that damage to the intestine may modulate HIV disease progression even before symptomatic gastrointestinal disease.…”

“…34,35 However, before late-stage AIDS most HIV-infected individuals had fairly normal gut structure and function. 34,35 More recently, attention has refocused on the impact of HIV on the gut, following the observation that damage to the intestine may modulate HIV disease progression even before symptomatic gastrointestinal disease. 36 HIV enteropathy is indistinguishable qualitatively from EE, and where these two enteropathies co-exist they differ only in degree.…”

“…37 To our knowledge, eight published studies have reported morphometric (N = 6) and/or permeability (N = 4) data in both early and late HIV infection. 9,34,35,[37][38][39][40][41] Of the morphometric studies, four 9,34,37,39 found no evidence of villous changes in early HIV infection but two 38,40 did. Crypt changes were observed in early infection in two 9,34 but not in others [37][38][39][40] ; generally it was the larger studies that found the difference.…”

HIV infection and the gastrointestinal immune system

“…[4][5][6] Histologically, the enteropathy involves inflammatory infiltrates of lymphocytes and damage to the GI epithelial layer, including villous atrophy, crypt hyperlasia, and villous blunting. [7][8][9] Importantly, these pathologic changes occur in the absence of the detectable bacterial, viral, or fungal enteropathogens that are often associated with enteropathy.…”