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

Research snapshot1

Human immunodeficiency virus (HIV) disease progression is often marked by enteropathy, which contributes to malabsorption of macro- and micro-nutrients and to progressive weight loss. Altered intestinal function may also lead to poor absorption of antiretroviral and anti-tuberculosis drugs, resulting in treatment failure. Little is known about the magnitude of intestinal dysfunction in the HIV-infected population, particularly in resource-poor countries such as India. This study investigated the association of intestinal dysfunction in HIV-infected individuals with nutritional status and low serum/plasma levels of antioxidant micronutrients, comparing levels with healthy seronegative controls in a rural population in India.

The study was carried out in 2006 in Tamil Nadu. The target population is mainly agrarian, with many being subsistence farmers and labourers. A cross-sectional survey was conducted among 45 consenting HIV-infected, antiretroviral therapy (ART) naive participants attending an HIV clinic and 45 age and socioeconomic matched HIV-negative, neighbourhood population controls. The extent of intestinal dysfunction was assessed using a D-xylose absorption test and association with nutritional compromise was measured by body mass index (BMI) and serum antioxidant levels.

Results found that a similar proportion of HIV-positive and HIV-negative participants had intestinal dysfunction (42.2% versus 44.4%) that was worse with advanced disease; an increasing gradient of low D-xylose absorption was noted with decreasing CD4 counts (32%, 50% and 58.3% among those with >350, 200-350 and <200 cells/mm3, respectively). Multivariate analysis revealed a significant association between intestinal dysfunction and low BMI (P=0.03) independent of HIV infection and calorie intake per day (P=0.02).

The findings suggest an underlying prevalence of enteropathy among the rural population in India which makes the HIV-positive population more vulnerable to nutritional compromise and rapid progression of disease. The authors conclude that weight loss in HIV-infected individuals should be investigated for intestinal dysfunction, especially in low-resource settings, to aid appropriate management.


Footnotes

1Isaac R, Paul B, Geethanajali FS, Kang G, Wanke C. (2017). Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India. Tropical Doctor, Vol.47 (1) 44-48.


 

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Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India. Field Exchange 55, July 2017. p19. www.ennonline.net/fex/55/roleofintestinaldysfunction