44 Tropical Doctor 47(1) Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India Rita Isaac 1 , Biswajit Paul 1 , FS Geethanajali 2 , Gagandeep Kang 3 and Christine Wanke 4 Abstract Human immunodeficiency virus (HIV) disease progression is often marked by significant weight loss with or without chronic diarrhoea. We studied the extent of intestinal dysfunction using a D-xylose absorption test and association with nutritional compromise as measured by body mass index (BMI) and serum antioxidants levels in HIV-infected individuals through a cross-sectional survey of 45 ART naı ¨ve, HIV-positive and 45, age–socioeconomic status matched negative controls in a rural population in India. More than 40% of HIV-positive and HIV-negative participants had intestinal dysfunction (42.2% vs. 44.4%). However 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/mm 3 , respectively). Multivariate analysis revealed a significant association between intestinal dysfunction and low BMI (P ¼ 0.03) independent of HIV infection and calorie intake per day (P ¼ 0.02). Weight loss in HIV-infected individuals should be investigated for intestinal dysfunction especially in low resource settings. Keywords Disease prevention, epidemiology, Asia, diagnosis Introduction In recent years human immunodeficiency virus (HIV) infection has become a manageable, chronic disease. Recent research on HIV has focused on co-morbidities and other changes that may jeopardize the quality of life of infected patients. It has been shown that HIV infection alters the structure of the gastrointestinal tract and, in particular, the function of the gut mucosa as a protective barrier. 1–3 HIV enteropathy denotes disrup- tion of intestinal endothelial integrity in HIV-infected individuals, pathologically characterised by inflamma- tion in the epithelium and lamina propria of the intes- tine and villous atrophy; many factors, including both host-related and environmental, can aggravate and lead to its development. Previous studies, mostly done in rich countries, have shown that HIV enteropathy, though mechanisms leading to it are not well under- stood, contributes to malabsorption of macro- and micro-nutrient deficiencies and to progressive weight loss. 4–8 Furthermore it is possible that altered intestinal function may lead to poor absorption of antiretroviral and anti-tuberculosis drugs, resulting in treatment failure. 9,10 Significant advances have been made con- cerning intestinal pathology associated with HIV infec- tion, 11 but, to our knowledge, little is known about the magnitude of intestinal dysfunction in the HIV-infected population. The consequence of this and other contri- buting factors in resource-poor countries including India have not been much described. This study was undertaken to measure the association of intestinal dys- function in HIV-infected individuals with nutritional 1 Associate Professor, RUHSA Department, Christian Medical College, Vellore, Tamil Nadu, India 2 Professor, Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India 3 Professor, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India 4 Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA Corresponding author: Rita Caroline Isaac, Professor and Head, RUHSA Department, Christian Medical College, RUHSA Campus, Vellore 632209, Tamil Nadu, India. Email: rita.isaac@cmcvellore.ac.in Tropical Doctor 2017, Vol. 47(1) 44–48 ! The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475515626338 tdo.sagepub.com