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Digestive Diseases and Sciences

, Volume 39, Issue 10, pp 2163–2169 | Cite as

Association of lipid accumulation in small intestinal mucosa with decreased serum triglyceride and cholesterol levels in AIDS

  • Y. Benhamou
  • I. Hilmarsdottir
  • I. Desportes-Livage
  • C. Hoang
  • A. Datry
  • M. Danis
  • M. Gentilini
  • P. Opolon
Intestinal Disorders, Inflammatory Bowel Disease, Immunology, And Microbiology

Abstract

Lipid accumulation has been described in the duodenal lamina propria of human immunodeficiency virus (HIV)-infected patients with diarrhea and malabsorption. Using light and electron microscopy, we studied duodenal biopsies obtained from 54 consecutive HIV-infected patients by means of upper gastrointestinal endoscopy after an overnight fast. The presence of diarrhea and weight loss were recorded, and all the patients had standard stool study for ova, parasites, and bacteria. Serum levels of albumin, triglycerides, and cholesterol were obtained within one week of the endoscopy. Fecal fat and fecal α1-antitrypsin clearance were measured in 11 patients. Lipid accumulation was observed in nine patients (16.6%). Fat droplets were seen in enterocytes, in their basolateral membrane spaces, and in the lamina propria. The mean serum levels of triglycerides (1.85±0.20 mmol/liter) and cholesterol (2.81±0.30 mmol/liter) were significantly lower in the patients with enteric steatosis than in patients without this anomaly (respectively, 3.38±0.39 and 3.97±0.18 mmol/liter,P<0.001P<0.01). The mean amount of fecal fat in the three patients with lipid accumulation (16±1.60 g/24 hr) was significantly larger than in the eight patients without lipid accumulation (4.50±0.62 g/24 hr,P<0.01). These findings suggest that fat malabsorption in HIV-infected individuals is due to a blockage of transport through the duodenal mucosa. The frequency of diarrhea, weight loss, or identified enteric pathogens did not differ significantly between patients with and without enteric steatosis. Both the etiology and the pathophysiology of these alterations remain to be documented.

Key words

AIDS enterocytes steatosis 

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References

  1. 1.
    Kotler DP, Gaetz HP, Lange M, Klein EB, Holt PR: Enteropathy associated with acquired immunodeficiency syndrome. Ann Intern Med 101:421–428, 1984PubMedGoogle Scholar
  2. 2.
    Gillin TS, Shike M, Alcock N, Urmacher C, Krown S, Kurtz RC, Lightdale CJ, Winawer SJ: Malabsorption and mucosal abnormalities of the small intestine in acquired immunodeficiency syndrome. Ann Intern Med 102:619–622, 1985PubMedGoogle Scholar
  3. 3.
    Miller ARO, Griffen GE, Batman P, Farquar C, Forster M, Pinching AJ, Harris JRW: Jejunal mucosa architecture and fat absorption in male homosexuals infected with human immunodeficiency virus. Q J Med 69:1009–1019, 1988PubMedGoogle Scholar
  4. 4.
    Dworkin B, Wormser GP, Rosenthal WS, Heier SK, Braunstein M, Weiss L, Jankowski R, Levy D, Weiselberg S: Gastrointestinal manifestations of the acquired immunodeficiency syndrome: a review of 22 cases. Am J Gastroenterol 80:774–778, 1985PubMedGoogle Scholar
  5. 5.
    Modigliani R, Bories C, Le Charpentier Y, Salmeron M, Messing B, Galian A, Rambaud JC, Lavergne A, Cochand-Priollet B, Desportes I: Diarrhoea and malabsorption in acquired deficiency syndrome: a study of four cases with special emphasis on opportunistic protozoan infection. Gut 26:179–187, 1985PubMedGoogle Scholar
  6. 6.
    Smith PD, Lane C, Gill VJ, Manischewitz JF, Quinnan GV, Fancy AS, Masur H: Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 108:328–333, 1988PubMedGoogle Scholar
  7. 7.
    Orenstein JM, Chiang J, Steinberg W, Smith PD, Rotterdam H, Kotler DP: Intestinal microsporidiosis as a cause of diarrhoea in human immunodeficiency virus-infected patients: A report of 20 cases. Hum Pathol 21:475–481, 1990PubMedGoogle Scholar
  8. 8.
    Ehrenpreis ED, Patterson BK, Brainer JA, Yokoo H, Rademaker AW, Glogowski W, Noskin GA, Graig RM: Histopathologic findings of duodenal biopsy specimens in HIV-infected patients with and without diarrhoea and malabsorption. Am J Clin Pathol 97:21–28, 1992PubMedGoogle Scholar
  9. 9.
    Mathan EM, Griffin GE, Miller A, Batman P, Forster S, Piching A, Harris W: Ultrastructure of the jejunal mucosa in human immunodeficiency virus infection. J Pathol 161:119–127, 1990PubMedGoogle Scholar
  10. 10.
    Ullrich R, Zeitz M, Heise W, L'age M, Hoffken G, Riecken EO: Small intestinal structure and function in patients infected with human immunodeficiency virus (HIV): Evidence for HIV-induced enteropathy. Ann Intern Med 111:15–21, 1989PubMedGoogle Scholar
  11. 11.
    Jarry A, Cartez A, René E, Muzeau F, Brousse N: Infected cells and immune cells in the gastrointestinal tract of AIDS patients: An immunohistochemical study of 127 cases. Histopathology 16:133–140, 1990PubMedGoogle Scholar
  12. 12.
    Center for Disease Control: Classification system for human T lymphotroic virus type III/lymphadenopathy associated virus infection. Ann Intern Med 105:234–237, 1986Google Scholar
  13. 13.
    Ashworth CT, Johnston JM: The intestinal absorption of fatty acid: a biochemical and electron microscopy study. J Lipid Res 4:454–460, 1963Google Scholar
  14. 14.
    Grunfeld C, Kotler DP, Hamadeh R, Tierney A, Wang J, Pierson RN Jr: Hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med 86:27–31, 1989Google Scholar
  15. 15.
    Schwartz R, Dean RFA: The serum lipids in Kwarshiorkor. 1. Neutral fat, phospholipids and cholesterol. J Trop Pediatr 3:23–28, 1957Google Scholar
  16. 16.
    Rachmilewitz D, Albers JJ, Saunders DR, Fainaru M: Apoprotein synthesis by human duodenojejunal mucosa. Gastroenterology 75:667–682, 1978Google Scholar
  17. 17.
    Glickman RM, Khorana J, Kigore A: Localization of apolipoprotein B in the intestinal epithelial cells. Science 193:1254–1255, 1976PubMedGoogle Scholar
  18. 18.
    Glickman RM, Green PHR: Immunofluorescence studies of apolipoprotein B in normal and abetalipoproteinemic intestinal mucosa. Absence in abetalipoproteinemia. Gastroenterology 76:288–292, 1979PubMedGoogle Scholar
  19. 19.
    Dobbins WO: An ultrastructural study of intestinal mucosa in congenital β lipoprotein deficiency with particular emphasis upon the intestinal absorptive cell. Gastroenterology 50:195–210, 1966Google Scholar
  20. 20.
    Waldman TA: Protein losing enteropathy: Intestinal lymphangiectasia. Gastroenterology 50:422–443, 1966PubMedGoogle Scholar
  21. 21.
    Yahi N, Baghdiguian S, Moreau H, Fantini J: Galactosyl ceramide (or closely related molecule) is the receptor for human immunodeficiency virus type 1 on human colon epithelial HT29 cells. J Virol 66:4848–4854, 1992PubMedGoogle Scholar
  22. 22.
    Beutler B, Cerami A: Cachectin: More than tumor necrosis factor. N Engl J Med 316:379–385, 1987PubMedGoogle Scholar
  23. 23.
    Wilson DE, Birchfield GR, Hejazi JS, Ward JH, Salmlowski WE: Hypocholesterolemia in patients treated with recombinant interleukin-2: appearance of remnant-like lipoproteins. J Clin Oncol 10:1573–1577, 1989Google Scholar
  24. 24.
    Ferreira RD, Forsyth LE, Richman PI, Wells C, Spencer J, MacDonald TT: Change in the rate of crypt epithelial cell proliferation and mucosal morphology induced by T-cell mediated response in human small intestine. Gastroenterology 98:1255–1263, 1990PubMedGoogle Scholar
  25. 25.
    MacDonald TT, Spencer J: Evidence that activated mucosa T cells play a role in the pathogenesis of entheropathy in human. J Exp Med 167:1341–1349, 1988PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Y. Benhamou
    • 1
  • I. Hilmarsdottir
    • 1
  • I. Desportes-Livage
    • 1
  • C. Hoang
    • 1
  • A. Datry
    • 1
  • M. Danis
    • 1
  • M. Gentilini
    • 1
  • P. Opolon
    • 1
  1. 1.From the Service d'Hépato-Gastroentérologie, Département des Maladies Infectieuses, Parasitaires, Tropicales et de Santé Publique, and Laboratoire d'Anatomie PathologiqueGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France

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