Enteropathy in Zambians with HIV related diarrhoea: regression modelling of potential determinants of mucosal damage
Kelly, P.; Davies, S.E.; Mandanda, B.; Veitch, A.; McPhail, G.; Zulu, I.; Drobniewski, F.; Fuchs, D.; Summerbell, C.; Luo, N.P.; Pobee, J.O.; Farthing, M.J.
Gut 41(6): 811-816
1997
ISSN/ISBN: 0017-5749 PMID: 9462215 DOI: 10.1136/gut.41.6.811Document Number: 278651
The relative contributions of enteric infection, nutritional impairment, and immune dysfunction to AIDS-related enteropathy were investigated in a comparative study of small intestinal biopsy specimens from 56 HIV-positive patients from Lusaka, Zambia, with persistent diarrhea and 26 diarrhea-free controls. Compared with both HIV-positive and HIV-negative controls, patients with HIV-related diarrhea had a 40% reduction in mean villous height and a 19% increase in mean crypt depth. In regression models applied to AIDS mucosal measurements, villous height and crypt depth were related to nutritional parameters and to the serum soluble tumor necrosis factor receptor p55 concentration. Crypt depth also was related to lamina propria plasma cell count. Intestinal infection, primarily microsporidia, was detected in 79% of cases; however, the presence of enteropathogens was not related to the severity of enteropathy. These findings suggest that nutritional and immune disturbances account for more than 33% of the variation in mucosal morphometric parameters in AIDS-related enteropathy.