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. 1989 Mar;42(3):275–281. doi: 10.1136/jcp.42.3.275

Jejunal enteropathy associated with human immunodeficiency virus infection: quantitative histology.

P A Batman 1, A R Miller 1, S M Forster 1, J R Harris 1, A J Pinching 1, G E Griffin 1
PMCID: PMC1141868  PMID: 2703544

Abstract

Jejunal biopsy specimens from 20 human immunodeficiency virus (HIV) positive male homosexual patients were analysed and compared with those of a control group to determine whether the abnormalities were caused by the virus or by opportunistic infection. The degree of villous atrophy was estimated with a Weibel eyepiece graticule, and this correlated strongly with the degree of crypt hyperplasia, which was assessed by deriving the mean number of enterocytes in the crypts. The density of villous intraepithelial lymphocytes fell largely within the normal range, either when expressed in relation to the number of villous enterocytes or in relation to the length of muscularis mucosae. Villous enterocytes showed mild non-specific abnormalities. Pathogens were sought in biopsy sections and in faeces. Crypt hyperplastic villous atrophy occurred at all clinical stages of HIV disease and in the absence of detectable enteropathogens. An analogy was drawn between HIV enteropathy and the small bowel changes seen in experimental graft-versus-host disease. It is suggested that the pathogenesis of villous atrophy is similar in the two states, the damage to the jejunal mucosa in HIV enteropathy being inflicted by an immune reaction mounted in the lamina propria against cells infected with HIV.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adachi A., Gendelman H. E., Koenig S., Folks T., Willey R., Rabson A., Martin M. A. Production of acquired immunodeficiency syndrome-associated retrovirus in human and nonhuman cells transfected with an infectious molecular clone. J Virol. 1986 Aug;59(2):284–291. doi: 10.1128/jvi.59.2.284-291.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adachi A., Koenig S., Gendelman H. E., Daugherty D., Gattoni-Celli S., Fauci A. S., Martin M. A. Productive, persistent infection of human colorectal cell lines with human immunodeficiency virus. J Virol. 1987 Jan;61(1):209–213. doi: 10.1128/jvi.61.1.209-213.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Budhraja M., Levendoglu H., Kocka F., Mangkornkanok M., Sherer R. Duodenal mucosal T cell subpopulation and bacterial cultures in acquired immune deficiency syndrome. Am J Gastroenterol. 1987 May;82(5):427–431. [PubMed] [Google Scholar]
  4. Corazza G. R., Frazzoni M., Gasbarrini G. Jejunal intraepithelial lymphocytes in coeliac disease: are they increased or decreased? Gut. 1984 Feb;25(2):158–162. doi: 10.1136/gut.25.2.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dobbins W. O., 3rd Human intestinal intraepithelial lymphocytes. Gut. 1986 Aug;27(8):972–985. doi: 10.1136/gut.27.8.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dobbins W. O., 3rd, Weinstein W. M. Electron microscopy of the intestine and rectum in acquired immunodeficiency syndrome. Gastroenterology. 1985 Mar;88(3):738–749. doi: 10.1016/0016-5085(85)90145-3. [DOI] [PubMed] [Google Scholar]
  7. Dunnill M. S., Whitehead R. A method for the quantitation of small intestinal biopsy specimens. J Clin Pathol. 1972 Mar;25(3):243–246. doi: 10.1136/jcp.25.3.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Elson C. O., Reilly R. W., Rosenberg I. H. Small intestinal injury in the graft versus host reaction: an innocent bystander phenomenon. Gastroenterology. 1977 May;72(5 Pt 1):886–889. [PubMed] [Google Scholar]
  9. Gillin J. S., Shike M., Alcock N., Urmacher C., Krown S., Kurtz R. C., Lightdale C. J., Winawer S. J. Malabsorption and mucosal abnormalities of the small intestine in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 May;102(5):619–622. doi: 10.7326/0003-4819-102-5-619. [DOI] [PubMed] [Google Scholar]
  10. Isaacs P. E., Sladen G. E., Filipe I. Mefenamic acid enteropathy. J Clin Pathol. 1987 Oct;40(10):1221–1227. doi: 10.1136/jcp.40.10.1221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jenkins D., Goodall A., Scott B. B. T-lymphocyte populations in normal and coeliac small intestinal mucosa defined by monoclonal antibodies. Gut. 1986 Nov;27(11):1330–1337. doi: 10.1136/gut.27.11.1330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kotler D. P., Gaetz H. P., Lange M., Klein E. B., Holt P. R. Enteropathy associated with the acquired immunodeficiency syndrome. Ann Intern Med. 1984 Oct;101(4):421–428. doi: 10.7326/0003-4819-101-4-421. [DOI] [PubMed] [Google Scholar]
  13. Kotler D. P., Weaver S. C., Terzakis J. A. Ultrastructural features of epithelial cell degeneration in rectal crypts of patients with AIDS. Am J Surg Pathol. 1986 Aug;10(8):531–538. doi: 10.1097/00000478-198608000-00002. [DOI] [PubMed] [Google Scholar]
  14. MacDonald T. T., Spencer J. Evidence that activated mucosal T cells play a role in the pathogenesis of enteropathy in human small intestine. J Exp Med. 1988 Apr 1;167(4):1341–1349. doi: 10.1084/jem.167.4.1341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Marsh M. N. Functional and structural aspects of the epithelial lymphocyte, with implications for coeliac disease and tropical sprue. Scand J Gastroenterol Suppl. 1985;114:55–75. doi: 10.3109/00365528509093768. [DOI] [PubMed] [Google Scholar]
  16. Mowat A. M., Ferguson A. Intraepithelial lymphocyte count and crypt hyperplasia measure the mucosal component of the graft-versus-host reaction in mouse small intestine. Gastroenterology. 1982 Aug;83(2):417–423. [PubMed] [Google Scholar]
  17. Nelson J. A., Wiley C. A., Reynolds-Kohler C., Reese C. E., Margaretten W., Levy J. A. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet. 1988 Feb 6;1(8580):259–262. doi: 10.1016/s0140-6736(88)90348-0. [DOI] [PubMed] [Google Scholar]
  18. Rodgers V. D., Fassett R., Kagnoff M. F. Abnormalities in intestinal mucosal T cells in homosexual populations including those with the lymphadenopathy syndrome and acquired immunodeficiency syndrome. Gastroenterology. 1986 Mar;90(3):552–558. doi: 10.1016/0016-5085(86)91108-x. [DOI] [PubMed] [Google Scholar]
  19. Schreiber D. S., Trier J. S., Blacklow N. R. Recent advances in viral gastroenteritis. Gastroenterology. 1977 Jul;73(1):174–183. doi: 10.1016/S0016-5085(19)32293-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Slavin R. E. Lymphocyte-associated apoptosis in AIDS, in bone-marrow transplantation, and other conditions. Am J Surg Pathol. 1987 Mar;11(3):235–238. doi: 10.1097/00000478-198703000-00012. [DOI] [PubMed] [Google Scholar]
  21. Sloane J. P., Dilly S. A. Pathogenesis of graft versus host disease. Histopathology. 1988 Jan;12(1):105–110. doi: 10.1111/j.1365-2559.1988.tb01921.x. [DOI] [PubMed] [Google Scholar]
  22. Weber J. R., Jr, Dobbins W. O., 3rd The intestinal and rectal epithelial lymphocyte in AIDS. An electron-microscopic study. Am J Surg Pathol. 1986 Sep;10(9):627–639. doi: 10.1097/00000478-198609000-00005. [DOI] [PubMed] [Google Scholar]
  23. Weiss R. A. Retroviruses and human disease. J Clin Pathol. 1987 Sep;40(9):1064–1069. doi: 10.1136/jcp.40.9.1064. [DOI] [PMC free article] [PubMed] [Google Scholar]

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