HIV enteropathy: comparative morphometry of the jejunal mucosa of HIV infected patients resident in the United Kingdom and Uganda

P A Batman,^a M S Kapembwa,^b A R O Miller,^c P M Sedgwick,^d S Lucas,^e N K Sewankambo,^h D Serwadda,^h J Pudney,ⁱ A Moody,^f J R W Harris,^g G E Griffin^d

^a Bradford Royal Infirmary, Bradford, ^b Northwick Park Hospital, Harrow, ^c Kidderminster General Hospital, ^d St George's Hospital Medical School, London, ^e St Thomas's Hospital, London, ^f Department of Clinical Parasitology, Hospital for Tropical Diseases, London, ^g St Mary's Hospital Medical School, London, UK, ^h Makerere University Faculty of Medicine, Kampala, Uganda, ⁱ Harvard Medical School, Boston, USA

Correspondence to: Dr P A Batman, Consultant Histopathologist, Bradford Royal Infirmary, Bradford, UK.

Accepted for publication 23 March 1998

AimsTo compare jejunal mucosal morphometry in HIV infected patients resident in London and Uganda.
PatientsTwenty HIV positive patients from London and 16 from Uganda were studied, and compared with HIV negative control subjects from both sites.
MethodsStools and biopsy specimens were examined for enteropathogens. Surface area to volume (S:V) ratio was estimated morphometrically, mean crypt length of jejunal biopsy specimens was measured, and HIV infected cells detected immunohistochemically were quantified.
ResultsEnteric pathogens were detected in none of the London patients, and in three Ugandan patients. S:V ratio was lower, and mean crypt length higher, in the specimens of London patients than in normal subjects, but there was no difference in S:V ratio or mean crypt length between Ugandan patients and controls. A negative correlation was present between S:V ratio and mean crypt length in all biopsy specimens analysed. HIV infected cells were detected only in lamina propria.
ConclusionInfection of cells in the lamina propria of the jejunum with HIV stimulates crypt cell proliferation, and a fall in villous surface area. The mucosal response to HIV is masked by other pathogens in the African environment.
(GUT 1998;43:350-355)

Keywords: HIV;  jejunum;  AIDS;  enteropathy