Fat Malabsorption Assessed by 14C-triolein Breath Test in HIV-positive Patients in Different Stages of Infection

Abstract

The aim of this study was to evaluate fat absorption in HIV-positive (HIV+) patients in different phases of HIV infection using a 14C-triolein breath test. We distributed 47 HIV+ patients according to the 1993 Centers for Disease Control Revised Classification: 20 in Group 2 (A1 or A2) and 27 in Group 3 (B1, B2, A3, B3, or C). Ten HIV-negative healthy subjects comprised the control group (Group 1). All individuals underwent a 14C-triolein breath test. Parasitic infection was evaluated through three stool exams, including Cryptosporidium and Isospora investigation. The median value of cumulative 6 hours' 14C excretion expressed as percentage of the 14C given as triolein was significantly higher in Group 1 (8.4%) than Group 2 (5.5%) or Group 3 (3.4%), p = 0.04 and p << 0.01, respectively. Fat malabsorption was found in 25% of Group 2 individuals, 52.6% of those without diarrhea in Group 3, and was correlated with CD4+ lymphocyte counts (p << 0.01). Fat malabsorption is a common feature in advanced stages of HIV infection, even in the absence of diarrhea and is also present in asymptomatic HIV+ patients. These findings suggest that malabsorption is an early event in HIV-infected individuals and is correlated with the degree of immunosuppression.

Immunopathology of the duodenal mucosa of HIV-positive patients during combined antiretroviral therapy

“…It has been shown that intestinal absorption is affected in the majority of HIV+ patients with AIDS and in some of the asymptomatic subjects (4,28). In the present study, no alteration was found, regardless of the stage of infection.…”

Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India

“…We expected a higher prevalence of intestinal dysfunction in HIV-positive participants although this clearly worsens as the disease progresses, which is no surprise. 17,18 Limitations of our study include the small sample size and the use of D-xylose as a marker of intestinal function, as this may not be as good as, for example, 72 h faecal fat and the lactuolose/mannitol intestinal permeability test. Nonetheless, our study had well-matched controls and precisely measured dietary intake data which have not been available in previous studies.…”

Malabsorption in wasting HIV disease: diagnostic and management issues in resource-poor settings

“…12,13 Further studies have shown that fat malabsorption is the most frequent problem in HIV disease (seen in 25-90% of infected people) and the frequency of fat malabsorption increases as the disease progresses. 14,15,16 Fat malabsorption impairs utilization of dietary fats which are food with a high calorie density. It causes abdominal symptoms such as diarrhoea and bloating which may further reduce food intake, and may be associated with micronutrient deficiencies from loss of fat-soluble vitamins.…”