Ultrasonography assessment of gut and mesenteric lymph nodes in hiv infected pediatric patients

Purpose: The gastrointestinal tract is a primary target for Human Immunodeficiency Virus (HIV) and it has been suggested as the main reservoir of HIV, despite antiretroviral therapy (HAART).

We performed a prospective study aimed at assessing gut involvement in HIV infected paediatric patients, either naïve and on HAART, through not invasive methods such as bowel ultrasound and faecal calprotectin (faecal marker of gut inflammation).

Material and methods: 30 HIV infected children and youth underwent in the same day a series of instrumental and biochemical tests aimed to assess both gut involvement and the control of HIV infection, through faecal calprotectin, bowel ultrasound, CD4 T cell count and HIV viral load. Bowel ultrasound included the evaluation of increased bowel wall thickness (> 2 mm) and enlargement of mesenteric lymph nodes (minor diameter > 8 mm).

Results: Faecal calprotectin was normal in 29 patients (mean value 63.8 ± 42.5 µg/g) and did not correlate with HIV-RNA (p: 0.704), CD4 cell absolute count (p: 0.134) and percentage (p: 0.994) and current HAART treatment (p: 0.493). No patients showed significant changes at bowel US except for enlarged mesenteric lymph nodes, which were found in 7 patients (23.3%). Presence of enlarged mesenteric lymph nodes significantly correlated with high HIV viral load (p: 0.001) and low CD4 percentage (p: 0.012) but not with faecal calprotectin (p: 0.912) and CD4 absolute count (p: 0.562).

Conclusion: HIV infected paediatric patients, either naïve and on HAART, did not have significant biochemical or ultrasonoghraphic signs of mucosal inflammation. Seven patients showed enlarged mesenteric lymph nodes, which correlated with uncontrolled HIV infection.