Intestinal Malabsorption of Hiv-infected Children - Relationship To Diarrhea, Failure-to-thrive, Enteric Microorganisms and Immune Impairment

Objective: To determine the features and the prevalence of intestinal-dysfunction in HIV-infected children and to investigate its relationship to diarrhoea, growth failure, immune dysfunction and enteric pathogens. Design: Case controlled, cross-sectional multicentre study. Setting: Children enrolled in tertiary care Italian centres for paediatric HIV infection from June 1990 to June 1992. Intestinal function tests and investigation for enteric viruses were performed in Naples. Patients: Forty-seven children with symptomatic HIV infection, six of whom had diarrhoea. Fifty non-infected children with diarrhoea and 48 healthy children were enrolled as controls for enteric viruses positivity and intestinal tests. Methods: Intestinal function was investigated by measuring fat, protein and carbohydrate absorption using the steatocrit method, and determining the faecal concentration alpha-1-antitrypsin and the d-xylose absorption, respectively. Microbiological studies included investigation for classical and opportunistic pathogens and for enteric viruses by electron microscopy in the stools of HIV-infected children. The presence of viruses in the stools of HIV-negative children was also investigated. Results: A high prevalence of intestinal-dysfunction was detected in HIV-infected children; faecal fat loss was detected in 14 out of 47 (30%), carbohydrate malabsorption in 1 5 out of 47 (32%) and protein loss in eight out of 47 (17%) HIV-infected children. Mean values of xylose blood level and of steatocrit were significantly different from those of healthy controls. Four children with diarrhoea were positive for Cryptosporidium. The prevalence of enteric viruses was significantly increased in HIV-infected children (57%) compared with healthy controls (17%). Intestinal-dysfunction was not associated with diarrhoea, poor growth, enteric agents or degree of immune dysfunction. Conclusions: Intestinal-dysfunction, consisting of fat, carbohydrate and protein malabsorption, is a common feature of paediatric HIV infection. Although not clinically evident, it may contribute to further worsening of the disease