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Mucosal injury and disruption of intestinal barrier function in HIV-infected individuals with and without diarrhea and cryptosporidiosis in northeast Brazil.
Am J Gastroenterol. 1997 Oct; 92(10):1861-6.AJ

Abstract

OBJECTIVES

To determine the relative effects of AIDS-related diarrhea with or without cryptosporidiosis and microsporidiosis on intestinal function and injury.

METHODS

We studied 40 HIV-infected patients (20 with and 20 without diarrhea) and 13 healthy volunteers, using the differential urinary excretion of ingested lactulose and mannitol as respective markers of barrier disruption and overall villous surface area. We also examined them for fecal leukocytes, lactoferrin, and alpha 1-antitrypsin. Fasting subjects drank test solution containing lactulose (5 g) and mannitol (1 g). Urine was collected for 5 h and tested for sugars by high-performance liquid chromatography with pulsed amperometric detection.

RESULTS

HIV-positive patients with diarrhea had a 2.8-fold higher lactulose:mannitol excretion ratio (L:M) than HIV-positive patients without diarrhea (p = 0.01) and 10.4-fold higher than healthy volunteers (p = 0.004). This was accounted for by a 1.5- to 3.1-fold higher rate of lactulose excretion by HIV patients with diarrhea than by those without diarrhea or by healthy volunteers. Mannitol excretion was 32-55% less in patients with diarrhea than in those without diarrhea or in healthy volunteers. Patients with cryptosporidial diarrhea had a nearly 6-fold higher L:M ratio than those without diarrhea (p < 0.001) and nearly 3-fold higher than those with non-cryptosporidial diarrhea (p = 0.02). One patient with microsporidial infection had a nearly 3-fold higher L:M ratio than controls without diarrhea. Alpha 1-Antitrypsin was positive in 40% of HIV-positive patients with cryptosporidial infections and none of 12 HIV-positive patients with non-cryptosporidial diarrhea. Fecal lactoferrin or leukocytes were increased in all HIV patients with diarrhea.

CONCLUSION

HIV infection is associated with intestinal dysfunction and injury, even in patients who do not have diarrhea. However, those with diarrhea, especially with cryptosporidiosis or microsporidiosis, have even greater disruption of intestinal barrier function with potentially important nutritional consequences.

Authors+Show Affiliations

Clinical Research Unit, University Hospital, Federal University of Ceará, Fortaleza, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9382053

Citation

Lima, A A., et al. "Mucosal Injury and Disruption of Intestinal Barrier Function in HIV-infected Individuals With and Without Diarrhea and Cryptosporidiosis in Northeast Brazil." The American Journal of Gastroenterology, vol. 92, no. 10, 1997, pp. 1861-6.
Lima AA, Silva TM, Gifoni AM, et al. Mucosal injury and disruption of intestinal barrier function in HIV-infected individuals with and without diarrhea and cryptosporidiosis in northeast Brazil. Am J Gastroenterol. 1997;92(10):1861-6.
Lima, A. A., Silva, T. M., Gifoni, A. M., Barrett, L. J., McAuliffe, I. T., Bao, Y., Fox, J. W., Fedorko, D. P., & Guerrant, R. L. (1997). Mucosal injury and disruption of intestinal barrier function in HIV-infected individuals with and without diarrhea and cryptosporidiosis in northeast Brazil. The American Journal of Gastroenterology, 92(10), 1861-6.
Lima AA, et al. Mucosal Injury and Disruption of Intestinal Barrier Function in HIV-infected Individuals With and Without Diarrhea and Cryptosporidiosis in Northeast Brazil. Am J Gastroenterol. 1997;92(10):1861-6. PubMed PMID: 9382053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mucosal injury and disruption of intestinal barrier function in HIV-infected individuals with and without diarrhea and cryptosporidiosis in northeast Brazil. AU - Lima,A A, AU - Silva,T M, AU - Gifoni,A M, AU - Barrett,L J, AU - McAuliffe,I T, AU - Bao,Y, AU - Fox,J W, AU - Fedorko,D P, AU - Guerrant,R L, PY - 1997/10/23/pubmed PY - 1997/10/23/medline PY - 1997/10/23/entrez KW - Acquired Immunodeficiency Syndrome KW - Americas KW - Brazil KW - Clinical Research KW - Developing Countries KW - Diarrhea KW - Diseases KW - Hiv Infections KW - Latin America KW - Parasitic Diseases KW - Research Methodology KW - Research Report KW - Signs And Symptoms KW - South America KW - Viral Diseases SP - 1861 EP - 6 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 92 IS - 10 N2 - OBJECTIVES: To determine the relative effects of AIDS-related diarrhea with or without cryptosporidiosis and microsporidiosis on intestinal function and injury. METHODS: We studied 40 HIV-infected patients (20 with and 20 without diarrhea) and 13 healthy volunteers, using the differential urinary excretion of ingested lactulose and mannitol as respective markers of barrier disruption and overall villous surface area. We also examined them for fecal leukocytes, lactoferrin, and alpha 1-antitrypsin. Fasting subjects drank test solution containing lactulose (5 g) and mannitol (1 g). Urine was collected for 5 h and tested for sugars by high-performance liquid chromatography with pulsed amperometric detection. RESULTS: HIV-positive patients with diarrhea had a 2.8-fold higher lactulose:mannitol excretion ratio (L:M) than HIV-positive patients without diarrhea (p = 0.01) and 10.4-fold higher than healthy volunteers (p = 0.004). This was accounted for by a 1.5- to 3.1-fold higher rate of lactulose excretion by HIV patients with diarrhea than by those without diarrhea or by healthy volunteers. Mannitol excretion was 32-55% less in patients with diarrhea than in those without diarrhea or in healthy volunteers. Patients with cryptosporidial diarrhea had a nearly 6-fold higher L:M ratio than those without diarrhea (p < 0.001) and nearly 3-fold higher than those with non-cryptosporidial diarrhea (p = 0.02). One patient with microsporidial infection had a nearly 3-fold higher L:M ratio than controls without diarrhea. Alpha 1-Antitrypsin was positive in 40% of HIV-positive patients with cryptosporidial infections and none of 12 HIV-positive patients with non-cryptosporidial diarrhea. Fecal lactoferrin or leukocytes were increased in all HIV patients with diarrhea. CONCLUSION: HIV infection is associated with intestinal dysfunction and injury, even in patients who do not have diarrhea. However, those with diarrhea, especially with cryptosporidiosis or microsporidiosis, have even greater disruption of intestinal barrier function with potentially important nutritional consequences. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9382053/Mucosal_injury_and_disruption_of_intestinal_barrier_function_in_HIV_infected_individuals_with_and_without_diarrhea_and_cryptosporidiosis_in_northeast_Brazil_ L2 - http://www.diseaseinfosearch.org/result/2029 DB - PRIME DP - Unbound Medicine ER -