Comparative assessment of small intestinal and colonic permeability in HIV-infected homosexual men

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Abstract
Objectives To investigate both small and large intestinal permeability in HIV-positive subjects, and correlate variation in intestinal mucosal abnormality with immunological and nutritional markers of HIV disease. Methods Small and large intestinal permeability studies were performed in 14 HIV-seropositive patients and eight healthy men. Eight out of the 14 patients had diarrhoea and all subjects were negative for enteropathogens. Small intestinal permeability was determined using the lactulose-mannitol test and large intestinal permeability using the colonic absorption of 51Cr-EDTA. In addition, CD4 cell count, β2-microglobulin, C-reactive protein estimation and anthropometry were carried out in all subjects. Results HIV-seropositive subjects had higher lactulose-mannitol ratios (LMR; 0.084±0.007 versus 0.013±0.0008) and lower 51Cr activity (1.986±0.066 versus 3.115±0.560) than controls (P51Cr-EDTA, but only for patients with diarrhoea (r=-0.81; P=0.015). Conclusion Regional variation affecting intestinal absorptive function occurs in patients with HIV-related diarrhoea and is characterized by increased LMR and reduced colonic uptake of 51Cr-EDTA. The pathogenesis and clinical significance of such changes are unknown.

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