Comparison of Intestinal Function in Human Immunodeficiency Virus-Seropositive Patients in Kampala and London

Abstract

Background: White homosexual men with human immunodeficiency virus (HIV) show progressive impairment of intestinal function assessed in terms of intestinal permeability and absorptive capacity. In this study we aimed to determine the effects of heterosexually acquired HIV on small-intestinal function in native Africans, among whom there is a high prevalence of tropical enteropathy. Methods: Intestinal absorptive capacity (using 3-O-methyl-D-glucose, D-xylose, and L-rhamnose) and permeability (differential 5-h urinary excretion of lactulose/L-rhamnose) were assessed in healthy white (n = 57) and black (n = 14) controls in London, apparently healthy black Africans in Kampala, Uganda (n = 26), HIV-infected patients with (n = 9) and without (n = 30) diarrhoea in Kampala, and 39 white homosexual men with HIV in London who were stratified to resemble the African patient group. Results: Intestinal integrity and absorptive capacity were significantly (P < 0.01) impaired in both black controls in London and apparently healthy black Africans, compared with white controls. HIV-infected white and black patients without diarrhoea did not differ significantly from white and black African controls, respectively, with the exception of increased intestinal permeability among the white patients. White and black African patients with HIV/acquired immunodeficiency syndrome (AIDS) and diarrhoea were found to have marked malabsorption and increased intestinal permeability. Although the relative increase in intestinal permeability was similar in the two groups, by far the largest values for intestinal permeability were found among black Africans with HIV/AIDS and diarrhoea. Conclusions: Whites and blacks differ with regard to intestinal barrier function. HIV-positive black Africans without gastrointestinal symptoms differ insignificantly from white Londoners with homosexually acquired disease, whereas those with gastrointestinal symptoms have markedly abnormal indices of small-intestinal function with severely comprised intestinal integrity.