Protein-losing enteropathy and hypoalbuminemia in AIDS

Abstract

To assess the contribution of protein-losing enteropathy to AIDS-associated hypoalbuminemia.

Prospective assessment of patients with AIDS.

An urban county hospital (Los Angeles & University of Southern California Medical Center. USA).

Four groups of patients with AIDS were studied: (1) patients with normal serum albumin (≥ 3.9g/dI) and normal bowel habits; (2) patients with normal serum albumin and diarrhea (≥ four loose or watery stools per day for ≥ 2 weeks); (3) patients with hypoalbuminemia (≤ 3.0g/dI) and normal bowel habits; and (4) patients with hypoalbuminemia and diarrhea.

Fecal α1-antitrypsin concentration was used as a measure of protein loss in the gut.

Patients with hypoalbuminemia had a significantly higher mean fecal α1-antitrypsin concentration than those with normal albumin (10.8 ± 3.0 mg/g dry stool versus 2.4 ± 0.4 mg/g dry stool; P ≤ 0.001). Although mean fecal α1-antitrypsin concentrations were similar in patients with and without diarrhea in the normal albumin group, patients with hypoalbuminemia and diarrhea had signficantly higher levels of fecal α1-antitrypsin than those with hypoalbuminemia and normal bowel habits (17.3 ± 5.8 mg/g dry stool versus 4.6 ± 1.0 mg/g dry stool; P = 0.009). Twelve out of 36 (33%) patients with normal albumin had elevation of fecal α1-antitrypsin compared with 33 (70%) of 47 patients with hypoalbuminemia (P ≤ 0.001). Linear regression analysis showed a significant negative correlation between serum albumin and fecal α1-antitrypsin concentration (r = −0.38; P ≤ 0.001). Fecal α1-antitrypsin was significantly higher in patients with mucosal disease visualized at upper endoscopy or flexible sigmoidoscopy than in those without gross abnormalities (13.5 ± 5.8 mg/g dry stool versus 2.4 ± 0.7 mg/g dry stool; P = 0.005).

Protein-losing enteropathy is common in patients with AIDS and may contribute to the development of hypoalbuminemia in these patients.