Investigation of Small Bowel Abnormalities in HIV-Infected Patients Using Capsule Endoscopy

Abstract

HIV infection is reportedly associated with an increased permeability of the intestinal epithelium and can cause HIV enteropathy, which occurs independently of opportunistic infections. However, the characteristics of small bowel abnormalities attributable to HIV infection are rarely investigated. In the present study, we assessed the intestinal mucosal changes found in HIV-infected patients and compared them with the mucosa of healthy control subjects using capsule endoscopy (CE). Three of the 27 HIV-infected patients harbored gastrointestinal opportunistic infections and were thus excluded from subsequent analyses. The endoscopic findings of CE in HIV-infected patients were significantly higher than those in control subjects (55% versus 10%, P = 0.002); however, most lesions, such as red spots or tiny erosions, were unlikely to cause abdominal symptoms. After validating the efficacy of CE for the diagnosis of villous atrophy, we found that the prevalence of villous atrophy was 54% (13/24) among HIV-infected patients. Interestingly, villous atrophy persisted in patients receiving long-term antiretroviral therapy, though most of them exhibited reconstituted peripheral blood CD4+ T cells. Although we could not draw any conclusions regarding the development of small bowel abnormalities in HIV-infected patients, our results may provide some insight regarding the pathogenesis of HIV enteropathy.

Figure 1

Representative images of villous atrophy. Villous atrophy was endoscopically diagnosed as positive when the reduction or absence of Kerckring's folds, a mosaic mucosal pattern and scalloping, was confirmed in the duodenum (a–c). A biopsy was performed at the lower duodenum, and villous atrophy was evaluated using the modified Marsh classification [17] (d–f). Marsh stage ≥ 3 was diagnosed as villous atrophy positive. (a) Nonatrophic villi. (b) Reduction of villi. (c) Mosaic pattern of mucosa. (d) Marsh 0. (e) Marsh 3a. (f) Marsh 3c.