Faecal tumour necrosis factor-alpha in individuals with HIV-related diarrhoea

• Published in: AIDS (London) Vol. 10; no. 9; p. 989
• Main Authors: Sharpstone, D R, Rowbottom, A W, Nelson, M R, Lepper, M W, Gazzard, B G
• Format: Journal Article
• Language: English
• Published: England 01.08.1996
• Subjects: AIDS-Related Opportunistic Infections - metabolism; AIDS-Related Opportunistic Infections - physiopathology; Diarrhea - etiology; Diarrhea - metabolism; Feces; HIV Infections - complications; Humans; Prospective Studies; Tumor Necrosis Factor-alpha - analysis
• ISSN: 0269-9370
• DOI: 10.1097/00002030-199610090-00009

HIV-related gastrointestinal infection is associated with diarrhoea, weight loss, mucosal inflammation and increased intestinal permeability. As tumour necrosis factor (TNF)-alpha may mediate these features this cytokine was measured in the faeces of HIV-seropositive individuals with diarrhoea to assess its role in the pathogenesis of HIV-related gastrointestinal disease and the association with specific intestinal pathogens. Prospective study. Two hundred and four HIV-seropositive individuals provided stool samples that were analysed for faecal TNF-alpha (FTNF-alpha) using a standard sandwich enzyme-linked immunosorbent assay. Stool from patients with bacterial, cytomegalovirus (CMV) and microsporidial diarrhoea had significantly elevated FTNF-alpha compared with those who had pathogen-negative diarrhoea (P < 0.05). FTNF-alpha was not raised in cryptosporidiosis, pathogen-negative or solid stool. In subjects with diarrhoea of more than 2 weeks duration and three stool samples negative for enteric pathogens, FTNF-alpha greater than 15 U/ml has a sensitivity of 88% and a specificity of 66% for the diagnosis of diarrhoea-related CMV enteritis. TNF-alpha production may have a role in the pathogenesis of bacterial, microsporidial and CMV-related diarrhoea in HIV-seropositive individuals. Thus, anti-TNF-alpha agents may have a therapeutic role in the management of these conditions. FTNF-alpha greater than 15 U/ml in apparently pathogen-negative diarrhoea may suggest endoscopic gastrointestinal biopsy to diagnose CMV enteritis.