Abstract
Background: Villous length, villous area, villous separation, villous tortuosity and crypt depth were evaluatedin thejejunal mucosaof HIV positive cases with chronic diarrhea and correlated with controls and CD4 counts. Methods: Endoscopicbiopsiesof jejunal mucosafrom30 confirmed HIV positive cases with enteropathyand 21 HIV negative controls were used.Villous parameters were assessed by computerized digital image morphometry on hematoxylin-eosin-stained histological sections. Results : There were no significant differences in the mean villous length (p=0.9858, case: 269µm, control:270µm) and villous area (p=0.0610, cases:30905µm 2 , controls:25864µm 2 ) between cases and controls. The mean villous separation (cases:188µm, controls:139µm) and crypt depth (cases:237µm, control:193µm) were significantly larger andmean villous tortuosity was significantly lower (cases:3.04, controls:3.92) in cases.In HIV cases, CD4 counts showed negative correlation with crypt depth (r=-0.524), villous area (r=-0.228), villous separation (r=-0.276) and positive correlation with villous tortuosity (r=0.297) in contrast to villous length (r=-0.012). Conclusion: Villous tortuosity was significantly reduced in the HIV cases; unlike villous length and villous area. Due to larger villous separation in HIV cases, villous surface area is likely to be lowered and hampered nutrient absorption. Crypt depth increased significantly in HIV positive cases and exhibited the best correlation with CD4 counts. DOI: 10.21276/APALM.1302
Highlights
Chronic diarrhea, malabsorption and weight loss are frequently observed in the human immunodeficiency virus (HIV) positive/AIDS cases[1,2,3]
At the time of biopsy, average duration of HIV infection for the cases was 4.5 years and average duration of antiretroviral therapy (ART) was 2.1 years(range: 0-9 years).hematoxylin & eosin (H&E) stained histological sections with villous atrophy and normal villous found in HIV positive cases are shown in Fig1A& B respectively; Fig1Cshows mucosa inHIV negative controls
Histological changes of the gastrointestinal mucosa and opportunistic infections due to the decrease of immunity are commonly observed in HIV positive cases . [1,2,3,4,5,6] Increased levels of inflammation and decreased levels of mucosal repair and regeneration have been seen in enteropathy with HIV infection[17]
Summary
Malabsorption and weight loss are frequently observed in the human immunodeficiency virus (HIV) positive/AIDS cases[1,2,3]. Evaluation of villous features is vital to assess the severity of modification of villous structure in enteropathy cases and to evaluate the effectiveness of a therapy[8,9,10,11,12,13,14,15,16]. Both histological changes and clinical symptoms in HIV infected patients can be resolved by highly active antiretroviral therapy (HAART)[3]. Morphometric evaluation of the intestinal mucosa will help in quantifying the histological changes in HIV infected patients with gastrointestinal (GI) symptoms
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