Document 0019
 DOCN  M9470019
 TI    [Gastrointestinal manifestations of HIV infection]
 DT    9409
 AU    Schneider T; Ullrich R; Zeitz M; Abteilung fur Innere Medizin mit
       Schwerpunkt Gastroenterologie,; Medizinische Klinik und Poliklinik,
       Klinikum Steglitz der Freien; Universitat Berlin.
 SO    Z Gastroenterol. 1994 Mar;32(3):174-81. Unique Identifier : AIDSLINE
       MED/94256165
 AB    The intestinal (in particular rectal) mucosa is the main portal of entry
       for HIV in homosexual men, who represent the vast majority of
       HIV-infected patients in Europe and North America. There are several
       possibilities for HIV to reach the CD4-positive T cells, macrophages and
       follicular-dendritic cells in the intestinal mucosa. HIV may be
       transported through M-cells directly to mucosal lymph follicles.
       Alternatively HIV may infect enterocytes via Fc-receptor by
       antibody-bound HIV or via a CD4-independent receptor. By successive
       budding on the basolateral side of the enterocytes HIV may be released
       into the lamina propria. The loss and functional impairment of activated
       CD4-positive lamina propria T-cells could be responsible for both the
       decreased immune defense and altered structure and function of the
       mucosa. The common intestinal symptoms in HIV-infected patients may be
       caused by a variety of mechanisms. The high number of secondary
       opportunistic or non-opportunistic infections and secondary malignancies
       of the gut may be responsible for the observed symptoms. However, the
       pathogenic relevance of some of these pathogens is questionable since
       there is often no correlation between symptoms and presence of the
       pathogen. In addition, there is a considerable percentage of symptomatic
       patients without identifiable microorganisms. Yet unidentified
       pathogens, small intestinal bacterial overgrowth, damage of intestinal
       nerve fibres, or secretory diarrhea may contribute to the pathogenesis
       of gastrointestinal symptoms. The findings of a pathogen-negative
       diarrhea, of HIV-infected mononuclear cells in the gut, and of
       epithelial hypoproliferation and enterocyte dysmaturation is in
       agreement with the hypothesis that there is an enteropathy caused by HIV
       itself.
 DE    AIDS-Related Opportunistic Infections/*DIAGNOSIS/IMMUNOLOGY/  PATHOLOGY
       English Abstract  Gastrointestinal
       Diseases/*DIAGNOSIS/IMMUNOLOGY/PATHOLOGY  Human  HIV
       Infections/*DIAGNOSIS/IMMUNOLOGY/PATHOLOGY  Intestinal
       Mucosa/IMMUNOLOGY/PATHOLOGY  Leukocyte Count  Microscopy, Electron
       T-Lymphocytes/IMMUNOLOGY  T4 Lymphocytes/IMMUNOLOGY  JOURNAL ARTICLE
       REVIEW  REVIEW, TUTORIAL

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