Small Intestinal Injury and Parasitic Diseases in AIDS

Abstract

Objectives: To examine jejunal biopsies from patients with the acquired immuodeficiency syndrome (AIDS), chronic diarrhea, and weight loss, and to correlate the presence of small intestinal injury with pathogens, histopathologic changes, and absorption. Disign: Prospective analysis of jejunal biopsies from 43 patients with AIDS, 10 patients with AIDS-related complex, and 6 heterosexual control volunteers. The biopsies were examined for pathogens; electron microscopy was used in 22 patients. The results of quantitative histologic measurements were correlated with histopathologic features and D-xylose absorption. Setting: A university-affiliated teaching hospital with many AIDS patients of varying demographic characteristics. Measurements and Main Results: Jejunal biopsies in 62% of the patients with AIDS had partial villus atrophy with or without crypt hyperplasia unlike those of controls, a result implying small intestinal injury. Small intestinal injury was associated with lymphoplasmacytic infiltration and cytopathic change of the villus epithelium. Light and electron microscopic examination detected cryptosporidia or microsporidia in 19 of 27 patients with small intestinal injury. The response of these parasites was associated with absorption in controls or in patients with AIDS, diarrhea, weight loss, and no parasites. Conclusion: A significant proportion of patients with AIDS with severe small intestinal injury have enterocyte infections. Like cryptosporidiosis, intestinal microsporidiosis may be an important cause of enteropathy in patients with AIDS.