Morphometric changes in jejunal mucosa in HIV positive patients presenting with enteropathy: An Indian study

  • Dibyajyoti Boruah Department of Pathology, Armed Forces Medical College, Pune-411040
  • Jasvinder K Bhatia Department of Pathology, Armed Forces Medical College, Pune-411040
  • Kiran Deep Kamal Department of Internal Medicine, Armed Forces Medical College, Pune-411040, Maharashtra, INDIA
  • Ajay Malik Department of Pathology, Army College of Medical Sciences, New Delhi, INDIA
Keywords: HIV, enteropathy, villous morphometry, crypt depth, CD4 counts


Background: Villous length, villous area, villous separation, villous tortuosity and crypt depth were evaluatedin thejejunal mucosaof HIV positive cases with chronic diarrhea and correlated with controls and CD4 counts.Methods: Endoscopicbiopsiesof jejunal mucosafrom30 confirmed HIV positive cases with enteropathyand 21 HIV negative controls were used.Villous parameters were assessed by computerized digital image morphometry on hematoxylin-eosin-stained histological sections.Results: There were no significant differences in the mean villous length (p=0.9858, case: 269µm, control:270µm) and villous area (p=0.0610, cases:30905µm2, controls:25864µm2) between cases and controls. The mean villous separation (cases:188µm, controls:139µm) and crypt depth (cases:237µm, control:193µm) were significantly larger andmean villous tortuosity was significantly lower (cases:3.04, controls:3.92) in cases.In HIV cases, CD4 counts showed negative correlation with crypt depth (r=-0.524), villous area (r=-0.228), villous separation (r=-0.276) and positive correlation with villous tortuosity (r=0.297) in contrast to villous length (r=-0.012).Conclusion: Villous tortuosity was significantly reduced in the HIV cases; unlike villous length and villous area. Due to larger villous separation in HIV cases, villous surface area is likely to be lowered and hampered nutrient absorption. Crypt depth increased significantly in HIV positive cases and exhibited the best correlation with CD4 counts. DOI: 10.21276/APALM.1302

Author Biographies

Dibyajyoti Boruah, Department of Pathology, Armed Forces Medical College, Pune-411040
Jasvinder K Bhatia, Department of Pathology, Armed Forces Medical College, Pune-411040
Ajay Malik, Department of Pathology, Army College of Medical Sciences, New Delhi, INDIA


1. Sharpstone D, Gazzard B. Gastrointestinal manifestations of HIV infection. Lancet 1996;348:379–83.
2. Owens SR, Greenson JK. The pathology of malabsorption: current concepts. Histopathology 2007; 50: 64–82.
3. Bhaijee F, Subramony C,Tang S, Pepper DJ. Human Immunodeficiency Virus Associated GastrointestinalDisease: Common Endoscopic Biopsy Diagnoses. Pathology Research International 2011; Article ID 247923, doi:10.4061/2011/247923.
4. Kotler DP, Giang TT, Thiim M, Nataro JP, Sordillo EM , Orenstein JM,et al. Chronic bacterial enteropathy in patients with AIDS. J Infect Dis1995;171:552-558.
5. Ullrich R, Zeitz M, Heise W, L’age M, Hofken G, Riecken EO. Small intestinal structure and function in patients infected with Human Immunodeficiency Virus: evidence for HIV- induced enteropathy. Ann Intern Med 1989; 111: 15-21.
6. Batman PA, Kapembwa MS, Miller ARO, Sedgwick PM, Lucas S, Sewankambo NK,et al.HIV enteropathy: comparative morphometry of the jejunal mucosa of HIV infected patients resident in the United Kingdom and Uganda. Gut 1998;43:350–355.
7. Cummins AG, LaBrooy JT, Stanley DP, Rowland R, Shearman DJC. Quantitative histological study of enteropathy associated with HIV infection. Gut1990;31:317–321.
8. Batman PA, Kapembwa MS, Belmonte L, Tudor G, Kotler DP, Potten CS et al. HIV enteropathy: HAART reduces HIV-induced stem cell hyperproliferation and crypt hypertrophy to normal in jejunal mucosa. J Clin Pathol 2014;67:14–18.
9. Batman PA, Miller AR0, Forster SM, Harris JRW, Pinching AJ, Griffin GE. Jejunal enteropathy associated with human Immunodeficiency virus infection: quantitative histology. J Clin Pathol 1989;42:275-281.
10. Keating J, Bjarnason I, Somasundaram S, Macpherson A, Francis N, Price AB et al. Intestinal absorptive capacity, intestinal permeability and jejunal histology in HIV and their relation to diarrhea. Gut 1995; 37: 623-629.
11. Kelly P, Davies SE, Mandanda B, Veitch A, McPhail G, Zulu I, et al. Enteropathy in Zambians with HIV related diarrhea: regression modeling of potential determinants of mucosal damage. Gut1997; 41: 811–816.
12. Pires ALG, da Silveira TR, da Silva VD. Digital morphometric and stereologic analysis of small intestinal mucosa in well-nourished and malnourished children with persistent diarrhea. J Pediatr (Rio J) 2003; 79:329-336.
13. Kelly P, Menzies I, Crane R, Zulu I, Nickols C, Feakins R etal. Responses of small intestinal architecture and function over time to environmental factors in a tropical population. Am J Trop Med Hyg2004; 70: 412–419.
14. Batmana PA, Kotlerb DP, Kapembwac MS, Boothd D, Pottend CS, Orenstein J M et al. HIV enteropathy: crypt stem and transit cell hyperproliferation induces villous atrophy in HIV/Microsporidia-infected jejunal mucosa. AIDS 2007; 21:433–439.
15. Cummins AG, Alexander BG, Chung A, Teo E, Woenig JA, Field JB, et al. Morphometric Evaluation of Duodenal Biopsies inCeliac Disease. Am J Gastroenterol 2011; 106:145–150.
16. Louis-Auguste J, Greenwald S, Simuyandi M, Soko R, Banda R and Kelly Paul. High dose multiple micronutrient supplementation improves villous morphology in environmental enteropathy without HIV enteropathy: results from a double-blind randomised placebo controlled trial in Zambian adults. BMC Gastroenterology 2014;14(15):1-10.
17. Brenchley JM, Douek DC. HIV infection and the gastrointestinal immuneSystem.MucosalImmunology2008; 1:1:23-30.
18. Maini M K, Gilson RJC, Chavda N, Gill S, Fakoya A, Ross EJ et al. Reference ranges and sources of variability of CD4 counts in HIV-seronegative women and men. Genitourin Med 1996;72:27-31.
19. Anukam KC, OsazuwaEO, Osadolor HB, Bruce AW and Reid GR, Yogurt Containing Probiotic Lactobacillus rhamnosus GR-1and L. reuteri RC-14 Helps Resolve Moderate Diarrheaand Increases CD4 Count in HIV/AIDS Patients. J Clin Gastroenterol2008; 42:239-243.
Original Article

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