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.
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-infectedpatients (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-positivepatients with diarrhea had a 2.8-fold higher lactulose:mannitol excretion ratio (L:M) than HIV-positivepatients 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 HIVpatients 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-positivepatients with cryptosporidial infections and none of 12 HIV-positivepatients with non-cryptosporidial diarrhea. Fecal lactoferrin or leukocytes were increased in all HIVpatients 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.
Entities:
Keywords:
Acquired Immunodeficiency Syndrome; Americas; Brazil; Clinical Research; Developing Countries; Diarrhea; Diseases; Hiv Infections; Latin America; Parasitic Diseases; Research Methodology; Research Report; Signs And Symptoms; South America; Viral Diseases
Authors: Jose Greenspon; Ruiyun Li; Lan Xiao; Jaladanki N Rao; Rex Sun; Eric D Strauch; Terez Shea-Donohue; Jian-Ying Wang; Douglas J Turner Journal: Dig Dis Sci Date: 2010-10-09 Impact factor: 3.199
Authors: Milena M Vieira; Jisun Paik; William S Blaner; Alberto M Soares; Rosa M S Mota; Richard L Guerrant; Aldo A M Lima Journal: J Pediatr Gastroenterol Nutr Date: 2008-11 Impact factor: 2.839
Authors: Cirle Alcantara Warren; Raul V Destura; Jesus Emmanuel A D Sevilleja; Luis F Barroso; Humberto Carvalho; Leah J Barrett; Alison D O'Brien; Richard L Guerrant Journal: J Infect Dis Date: 2008-07-01 Impact factor: 5.226
Authors: B A Carneiro-Filho; I P F Lima; D H Araujo; M C Cavalcante; G H P Carvalho; G A C Brito; V Lima; S M N Monteiro; F N Santos; R A Ribeiro; A A M Lima Journal: Dig Dis Sci Date: 2004-01 Impact factor: 3.199
Authors: Manuel B Braga Neto; Carolina V Aguiar; Jamilly G Maciel; Bruna M C Oliveira; Jesus E Sevilleja; Reinaldo B Oriá; Gerly A C Brito; Cirle A Warren; Richard L Guerrant; Aldo A M Lima Journal: BMC Gastroenterol Date: 2010-08-11 Impact factor: 3.067