RESUMEN
OBJECTIVES: Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. METHODS: The study involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index <18.5 kg/m2 ) and requiring ART. The relationship of grip strength to nutritional, infectious and demographic factors was assessed by multivariable linear regression at referral for ART (n = 1742) and after 12 weeks (n = 778) and 2-3 years of ART (n = 273). RESULTS: In analyses controlled only for sex, age and height, most nutrition and infection-related variables were associated with grip strength. However, in multivariable analyses, consistent associations were seen for fat-free mass index, mid-upper arm circumference, haemoglobin and systolic blood pressure, and a variable association with fat mass index in men. C-reactive protein and CD4 count had limited independent effects on grip strength, while receiving tuberculosis treatment was associated with weaker grip strength. CONCLUSIONS: In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment and management and could use grip strength as a functional indicator of improving nutrition.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Fuerza de la Mano/fisiología , Estado Nutricional/fisiología , Adolescente , Adulto , Fármacos Anti-VIH/farmacología , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/fisiopatología , Síndrome de Emaciación por VIH/complicaciones , Síndrome de Emaciación por VIH/diagnóstico , Síndrome de Emaciación por VIH/etiología , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Dinamómetro de Fuerza Muscular , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Tanzanía , Adulto Joven , ZambiaRESUMEN
BACKGROUND: Human immunodeficiency virus (HIV)-infected children are particularly susceptible to acute respiratory infections (ARIs). We determined incidence and cofactors for ARIs in HIV-infected infants receiving antiretroviral therapy (ART). METHODS: Human immunodeficiency virus-infected infants initiated ART at ≤12 months of age and were observed monthly for 2 years in Nairobi. Acute respiratory infection rates and cofactors were determined using Andersen-Gill models, allowing for multiple events per infant. RESULTS: Among 111 HIV-infected infants, median age at ART initiation was 4.5 months. Pre-ART median CD4% was 19%, and 29% had wasting. During 24-months follow-up while on ART, upper respiratory infection (URI) and pneumonia rates were 122.6 and 34.7 per 100 person-years (py), respectively. Infants with higher pre-ART viral load (VL) (plasma HIV ribonucleic acid [RNA] ≥7 log10 copies/mL) had 4.12-fold increased risk of pneumonia (95% confidence interval [CI], 2.17-7.80), and infants with wasting (weight-for-height z-score < -2) had 2.87-fold increased risk (95% CI, 1.56-5.28). Infants with both high pre-ART VL and wasting had a higher pneumonia rate (166.8 per 100 py) than those with only 1 of these risk factors (44.4 per 100 py) or neither (17.0 per 100 py). Infants with exposure to wood fuel had significantly higher risk of URI (hazard ratio [HR] = 1.82; 95% CI, 1.44-2.28) and pneumonia (HR = 3.31; 95% CI, 1.76-6.21). CONCLUSIONS: In early ART-treated HIV-infected infants, higher HIV RNA and wasting before ART were independent risk factors for pneumonia. Wood fuel use was associated with URI and pneumonia. Additional data on air pollution and respiratory outcomes in HIV-infected children may help optimize interventions to improve their lung health.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Síndrome de Emaciación por VIH/epidemiología , Neumonía/epidemiología , Viremia/epidemiología , Femenino , Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH/etiología , Humanos , Lactante , Kenia , Masculino , Neumonía/etiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Factores de Riesgo , Viremia/etiologíaRESUMEN
The review of literature analyzes scientific data on wasting syndrome in HIV-infected patients. It considers its etiology, diagnosis,and therapeutic approaches.
Asunto(s)
Síndrome de Emaciación por VIH , Síndrome de Emaciación por VIH/diagnóstico , Síndrome de Emaciación por VIH/tratamiento farmacológico , Síndrome de Emaciación por VIH/etiología , HumanosRESUMEN
Hypogonadism is a common complication among HIV infected patients. The prevalence of hypogonadism is 30 to 50% in HIV infected men with wasting syndrome and 20 to 25% in those without wasting syndrome. HIV infection affects the entire hypothalamus-pituitary-gonadal axis via both direct and indirect effects, which are defined in four categories, 1) direct effect of HIV particles, 2) opportunistic infections, 3) HIV-related malignancy and its treatment, and 4) medications that are used for HIV infection or its opportunistic infection. The association between HIV infection, hypogonadism, and cardiovascular diseases has yet to be determined; however, there are data that HIV infection and its treatment, particularly protease inhibitors, worsened the metabolic profiles, which were surrogate markers of cardiovascular diseases. Considerably more attention should be paid to the diagnosis of hypogonadism in this group particularly because HIV infection increases both sex hormone-binding globulin and total testosterone level. Testosterone replacement shows benefits on mood, body composition, and seems to benefit the metabolic profile in HIV infected men with low body mass index.
Asunto(s)
Infecciones por VIH/complicaciones , Hipogonadismo/etiología , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Inhibidores de la Proteasa del VIH/uso terapéutico , Síndrome de Emaciación por VIH/etiología , Humanos , Hipogonadismo/tratamiento farmacológico , Hipogonadismo/epidemiología , Masculino , PrevalenciaRESUMEN
Optimal nutrition is an important part of human immunodeficiency virus (HIV) care; to support the immune system, limit HIV-associated complications as well as maintain better quality of life and survival. The presentation and nature of malnutrition in patients with HIV has changed dramatically over the past 30 years from predominantly a wasting syndrome to lipodystrophy and, now, frailty. Nevertheless, we continue to see all 3 presentations in patient care today. The pathogenesis of poor nutrition in HIV-infected patients depends on caloric intake, intestinal nutrient absorption/translocation, and resting energy expenditure, which are features seen in all chronic diseases.
Asunto(s)
Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH/etiología , Estado Nutricional , Obesidad/etiología , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Síndrome de Emaciación por VIH/dietoterapia , Síndrome de Emaciación por VIH/epidemiología , VIH-1 , Síndrome de Lipodistrofia Asociada a VIH/epidemiología , Síndrome de Lipodistrofia Asociada a VIH/etiología , Síndrome de Lipodistrofia Asociada a VIH/terapia , Humanos , Trastornos Nutricionales/epidemiología , Trastornos Nutricionales/etiología , Obesidad/epidemiologíaAsunto(s)
Alopecia/etiología , Dermatosis del Pie/etiología , Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH/etiología , Dermatosis de la Mano/etiología , Sífilis/diagnóstico , Uveítis Anterior/etiología , Uveítis Intermedia/etiología , Adulto , Humanos , Masculino , Penicilinas/uso terapéutico , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Pérdida de PesoRESUMEN
In the era of highly active antiretroviral therapy, long-term complications of HIV infection and antiretroviral therapy deserve heightened attention. Morphologic and metabolic complications seen during the course of HIV infection encompass a variety of entities that may share a common pathophysiologic pathway. This review article will discuss clinical syndromes such as wasting, lipoatrophy/lipohypertrophy, polymetabolic syndrome as well as hyperlipidemia, cardiovascular disease, lactic acidosis, and metabolic bone disease in HIV-infected patients.
Asunto(s)
Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH/diagnóstico , Enfermedades Metabólicas/diagnóstico , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/etiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Dislipidemias/diagnóstico , Dislipidemias/etiología , Infecciones por VIH/fisiopatología , Síndrome de Emaciación por VIH/etiología , Síndrome de Lipodistrofia Asociada a VIH/diagnóstico , Síndrome de Lipodistrofia Asociada a VIH/etiología , Humanos , Enfermedades Metabólicas/etiologíaRESUMEN
HIV-infected persons often experience a loss of lean tissue mass, which includes decreases in skeletal muscle mass. This HIV-associated wasting is significant because it has been associated with accelerated disease progression and increased morbidity. Signalling related to several circulating molecules, including tumour necrosis factor (TNF)-alpha, growth hormone, insulin-like growth factor (IGF)-1 and testosterone, has been associated with the aetiology of muscle wasting. Additionally, nutritional status related to malnutrition and specific dietary deficiencies may be involved. In an attempt to counter muscle wasting in HIV-infected persons, treatments have been suggested that target these mechanisms. Nutritional supplementation, cytokine reduction, hormone therapy and resistance exercise training are potential treatments for this condition. Resistance exercise training, which is more easily accessible to this population than other treatments, holds promise in counteracting the process of HIV wasting, as it has been successfully used to increase lean tissue mass in healthy and clinical populations. This review will explore the HIV/AIDS muscle-wasting syndrome, its aetiology, and the treatments used to counteract wasting.
Asunto(s)
Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH , Citocinas/uso terapéutico , Terapia por Ejercicio , Hormona del Crecimiento/uso terapéutico , Síndrome de Emaciación por VIH/etiología , Síndrome de Emaciación por VIH/terapia , Terapia de Reemplazo de Hormonas , Humanos , Factor I del Crecimiento Similar a la Insulina/uso terapéutico , Desnutrición/dietoterapia , Desnutrición/etiología , Atrofia Muscular/etiología , Atrofia Muscular/terapia , Nandrolona/análogos & derivados , Nandrolona/uso terapéutico , Nandrolona Decanoato , Testosterona/uso terapéuticoRESUMEN
Since the earliest reports of human immunodeficiency virus (HIV) disease, undernutrition has been associated with HIV infection, typically with the late stages of the disease (namely acquired immunodeficiency syndrome), and may advance to severe wasting and cachexia. Specific micronutrient deficiencies are also recognized to occur with HIV infection, but their actual effect on the clinical course of the disease is hard to assess. The studies reviewed provide more insight into the complex interface between undernutrition and, in some cases, obesity and HIV/acquired immunodeficiency syndrome and highlight the possibility of alleviating or curing undernutrition by means of simple and comparatively inexpensive dietary adjustments.
Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/metabolismo , Desnutrición/etiología , Micronutrientes/deficiencia , Estado Nutricional , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/metabolismo , Síndrome de Emaciación por VIH/dietoterapia , Síndrome de Emaciación por VIH/etiología , Humanos , Desnutrición/dietoterapia , Evaluación Nutricional , Obesidad/complicacionesRESUMEN
Cachexia causes weight loss and increased mortality. It affects more than 5 million persons in the United States. Other causes of weight loss include anorexia, sarcopenia, and dehydration. The pathophysiology of cachexia is reviewed in this article. The major cause appears to be cytokine excess. Other potential mediators include testosterone and insulin-like growth factor I deficiency, excess myostatin, and excess glucocorticoids. Numerous diseases can result in cachexia, each by a slightly different mechanism. Both nutritional support and orexigenic agents play a role in the management of cachexia.
Asunto(s)
Envejecimiento/fisiología , Caquexia , Citocinas/fisiología , Anorexia/etiología , Anorexia/fisiopatología , Artritis Reumatoide/complicaciones , Caquexia/etiología , Caquexia/patología , Caquexia/fisiopatología , Caquexia/prevención & control , Enfermedad Crónica , Citocinas/sangre , Glucocorticoides/sangre , Glucocorticoides/fisiología , Síndrome de Emaciación por VIH/etiología , Humanos , Factor I del Crecimiento Similar a la Insulina/fisiología , Fallo Renal Crónico/complicaciones , Miostatina , Neoplasias/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Testosterona/sangre , Testosterona/fisiología , Factor de Crecimiento Transformador beta/sangre , Factor de Crecimiento Transformador beta/fisiología , Pérdida de PesoRESUMEN
Despite major advances in the treatment and survival of patients infected with human immunodeficiency virus (HIV), weight loss and wasting remain common problems. In the HIV-infected population, weight loss is associated with lower CD4+ cell counts and is an independent predictor of mortality. The etiology of weight loss and wasting is complex and multifactorial. We discuss, on the basis of a large longitudinal cohort that examined nutritional status in HIV infection, data on weight loss and wasting from the present clinical era. The definition, prevalence, and significance of HIV-associated weight loss and wasting are summarized. The etiology of weight loss is discussed for 2 main categories: inadequate nutrient intake and altered metabolism. Finally, studies of interventions to treat HIV-associated weight loss and wasting are discussed. This information is intended to raise awareness among health care providers of HIV-infected patients that weight loss and wasting remain important acquired immunodeficiency syndrome-defining conditions, despite the advent of HAART.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Síndrome de Emaciación por VIH/etiología , Síndrome de Emaciación por VIH/terapia , Pérdida de Peso , Metabolismo Basal , Estudios de Cohortes , Femenino , Síndrome de Emaciación por VIH/epidemiología , Humanos , Masculino , Fenómenos Fisiológicos de la NutriciónRESUMEN
Introduction of highly active antiretroviral therapy (HAART) has dramatically modified the natural history of HIV disease, but lengthening the survival of HIV-infected individuals has been associated with an increasing prevalence of iatrogenic conditions. Muscular complications of HIV infection are classified as follows: (1) HIV-associated myopathies and related conditions including polymyositis, inclusion-body myositis, nemaline myopathy, diffuse infiltrative lymphocytosis syndrome (DILS), HIV-wasting syndrome, vasculitis, myasthenic syndromes, and chronic fatigue; (2) iatrogenic conditions including mitochondrial myopathies, HIV-associated lipodystrophy syndrome, and immune restoration syndrome; (3) opportunistic infections and tumor infiltrations of skeletal muscle; and (4) rhabdomyolysis. These features are described in the present review.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/complicaciones , Enfermedades Musculares/etiología , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Fármacos Anti-VIH/efectos adversos , Antimetabolitos/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades Autoinmunes/etiología , Síndrome de Fatiga Crónica/etiología , Infecciones por VIH/tratamiento farmacológico , Síndrome de Emaciación por VIH/etiología , Síndrome de Lipodistrofia Asociada a VIH/etiología , Humanos , Enfermedad Iatrogénica , Linfoma Relacionado con SIDA/etiología , Miopatías Mitocondriales/inducido químicamente , Miastenia Gravis/etiología , Mioglobinuria/etiología , Nucleósidos/efectos adversos , Polimiositis/etiología , Polimiositis/inmunología , Polimiositis/patología , Polimiositis/terapia , Rabdomiólisis/etiología , Vasculitis/etiologíaRESUMEN
BACKGROUND: A decrease in the rate of human immunodeficiency virus (HIV) infection-related wasting has been reported in the era of highly active antiretroviral therapy (HAART). We investigated this concern in a hard-to-reach population of HIV-infected drug users in Miami, Florida. METHODS: After informed consent was obtained, 119 HIV-infected drug users were administered questionnaires involving demographic, medical history, and food-security information. Blood samples were drawn for immunological and viral studies. HIV-related wasting over a period of > or =6 months was defined as a body mass index of <18.5 kg/m2, unintentional weight loss of > or =10% over 6 months, or a weight of <90% of the ideal body weight. RESULTS: The prevalence of HIV-related wasting was 17.6%. A significantly higher proportion of those who experienced wasting (81%) reported that there were periods during the previous month when they went for > or =1 day without eating (i.e., food insecurity), compared with those who did not experience wasting (57%). Although a greater percentage of patients who experienced wasting were receiving HAART, their HIV RNA levels were more than twice as high (mean+/-standard deviation [SD], 166,689+/-238,002 copies/mL; median log HIV RNA level +/- SD, 10.2+/-2.7 log10 copies/mL) as those for the group that did not experience wasting (mean+/-SD, 72,156 +/- 149,080; median log HIV RNA level+/-SD, 9.2+/-2.3 log10 copies/mL). Participants who experienced wasting were more likely to be heavy alcohol drinkers and users of cocaine. In multivariate analysis that included age, sex, food security, alcohol use, cocaine use, viral load, and receipt of antiretroviral therapy, the only significant predictors of wasting were > or =1 day without eating during the previous month (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.18-3.26; P=.01) and viral load (OR, 1.64; 95% CI, 1.00-2.69; P=.05). CONCLUSIONS: HIV-related wasting continues to be common among HIV-infected drug users, even among HAART recipients. Food insecurity and viral load were the only independent predictors of wasting. The social and economic conditions affecting the lifestyle of HIV-infected drug users constitute a challenge for prevention and treatment of wasting.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Síndrome de Emaciación por VIH/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Dieta , Femenino , Florida/epidemiología , Síndrome de Emaciación por VIH/tratamiento farmacológico , Síndrome de Emaciación por VIH/etiología , Personas con Mala Vivienda , Humanos , Masculino , Oportunidad Relativa , Prevalencia , Calidad de Vida , ARN Viral , Factores de Riesgo , Factores Socioeconómicos , Carga ViralRESUMEN
Human immunodeficiency virus (HIV) infection in peripheral blood mononuclear cells (PBMCs) might be influencing the development of wasting in the era of potent antiretroviral therapy. In a retrospective study of 57 subjects, HIV proviral DNA levels in PBMCs were higher in subjects whose body weight decreased by >5% one year after initiation of highly active antiretroviral therapy, compared with subjects whose body weight was stable or increased (median HIV proviral DNA load, 8.9 vs. 0.9 copies/10(6) PBMCs; P = .006).
Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Síndrome de Emaciación por VIH/etiología , Síndrome de Emaciación por VIH/virología , Monocitos/virología , Adulto , Antivirales/uso terapéutico , Peso Corporal , Recuento de Linfocito CD4 , Estudios de Casos y Controles , ADN Viral , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Carga ViralRESUMEN
Wasting and renal diseases are frequent complications of HIV (human immunodeficiency virus) infection and are associated with accelerated disease progression and increased mortality. Transgenic mice expressing HIV1 under control of the CD4 promoter develop an AIDS-like disease and were used in the present work to study HIV1-induced wasting and kidney pathology. In this study, we reported that disease evolution paralleled increases in serum urea and creatinine levels, indicating an early and progressive deterioration of kidney function; meanwhile the wasting syndrome characterized by up-regulation of the ubiquitine-proteasome pathway and increased level of serum 3-methyl-histidine levels occurred at later stages just prior to death. Further examination of kidney and muscle pathologies revealed a progressive accumulation of CD45(+) cells, first affecting the kidneys. In addition, the onset of disease is accompanied by elevated levels of circulating "regulated on activation, normal and secreted T cell expressed and secreted" (RANTES). These results prompted us to assess the effects of AS602868, a specific small molecule inhibitor of IkappaB kinase 2 (IKK2) on disease progression. Inhibition of the NF-kappaB pathway indeed resulted in increased lifespan, kidney and lean body mass preservation. These beneficial results were associated with a reduction of CD45(+) cells infiltrating the kidneys, amelioration of the renal architecture, and reduced level of circulating RANTES. Together our data provide evidence that IKK2 inhibitors have therapeutic relevance in the treatment of HIV1-associated disorders.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Inhibidores Enzimáticos/farmacología , Síndrome de Emaciación por VIH/tratamiento farmacológico , Enfermedades Renales/tratamiento farmacológico , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Animales , Northern Blotting , Células Cultivadas , Quimiocina CCL5/sangre , Creatinina/sangre , Modelos Animales de Enfermedad , Femenino , Síndrome de Emaciación por VIH/etiología , VIH-1 , Humanos , Quinasa I-kappa B , Enfermedades Renales/sangre , Enfermedades Renales/etiología , Enfermedades Renales/patología , Antígenos Comunes de Leucocito/metabolismo , Leucocitos/metabolismo , Masculino , Ratones , Ratones Transgénicos , Músculo Esquelético/patología , Urea/sangreAsunto(s)
Infecciones por VIH/complicaciones , Síndrome de Emaciación por VIH/prevención & control , Anabolizantes/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Terapia Antirretroviral Altamente Activa/métodos , Composición Corporal , Femenino , Infecciones por VIH/terapia , Síndrome de Emaciación por VIH/etiología , Síndrome de Emaciación por VIH/mortalidad , Humanos , Masculino , Nandrolona/uso terapéutico , Estado Nutricional , Oxandrolona/uso terapéuticoRESUMEN
OBJECTIVE: To compare the intestinal absorptive capacity, permeability function and duodenal histopathology in human immunodeficiency virus (HIV) patients with or without wasting syndrome who had not suffered from chronic diarrhea. METHOD: Adult HIV patients who attended Chulalongkorn Hospital were included. The subjects were classified into wasting and non-wasting groups (group I and group II). 25 g oral D-xylose test, oral phenolsulfonephthalein test and duodenal histopathology were performed. RESULTS: Of thirty-two HIV patients, aged between 25-50 years enrolled, there were 18 and 14 patients in group I and group II, respectively. In both groups, the baseline data, permeability function and histopathology were similar. Intestinal absorptive capacity was statistically different, i.e. 5-hour urine D-xylose was 3.96 +/- 2.81 g and 5.95 +/- 2.47 g in group I and group II respectively (p < 0.05). CONCLUSION: This study demonstrated that D-xylose absorption was decreased in non-diarrheal, wasting HIV infected patients. Abnormal absorptive capacity is a common phenomenon found in HIV patients with wasting syndrome as determined by standard 25 g oral D-xylose test.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Diarrea/etiología , Diarrea/fisiopatología , Síndrome de Emaciación por VIH/etiología , Síndrome de Emaciación por VIH/fisiopatología , Absorción Intestinal/fisiología , Xilosa/farmacocinética , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
To evaluate the contribution of acquired immune deficiency syndrome-defining conditions (ADCs) in human immunodeficiency virus (HIV)-associated wasting, we analyzed longitudinal data from 671 participants in a nutrition and HIV cohort study. Data on ADCs, height, and weight were collected at baseline and during 6 monthly study visits. The frequency of ADCs decreased over time, but the relative risk (RR) of wasting (decrease in body mass index [BMI] to <20 kg/m(2)) increased with a history of >1 ADC; the RR of wasting increased 1.3-fold with each additional historical ADC. Any ADC during the 6 months prior to a study visit was associated with a decrease in BMI to <20 kg/m(2). The risk of wasting increased 2.7-fold with each additional recent ADC. These risks were not altered when adjusted for socioeconomic status, CD4 cell count, energy intake, or baseline BMI. Although ADCs contribute to the development of wasting, their contribution is relatively small.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Síndrome de Emaciación por VIH/etiología , Adulto , Índice de Masa Corporal , Recuento de Linfocito CD4 , Ingestión de Energía , Femenino , Síndrome de Emaciación por VIH/epidemiología , Síndrome de Emaciación por VIH/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SocioeconómicosRESUMEN
The presentation of the nutritional problems of HIV-infected children is changing over time with improved antiretroviral regimens. Early reports of HIV infection in the 1980s, included such problems as malnutrition and wasting. However, as treatment and prophylactic regimens improve, the current nutritional problems of HIV-infected children in developed countries include truncal obesity and insulin resistance in addition to malnutrition. Background data on the wasting syndrome, etiology of malnutrition, nutritional effects of highly active antiretroviral therapies, and nutritional intervention strategies for HIV-infected children will be presented.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Niño , Suplementos Dietéticos , Nutrición Enteral , Síndrome de Emaciación por VIH/dietoterapia , Síndrome de Emaciación por VIH/etiología , Humanos , Acetato de Megestrol/uso terapéutico , Trastornos Nutricionales/dietoterapia , Trastornos Nutricionales/etiología , Nutrición ParenteralRESUMEN
Although catastrophic weight loss is no longer common in HIV-infected men, we hypothesized that a more gradual process of cachexia [loss of lean body mass (LBM) without severe weight loss, often accompanied by elevated resting energy expenditure (REE)] is still common and is driven by excessive production of the catabolic cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta). We performed a longitudinal analysis of an ongoing cohort study of nutritional status in 172 men with HIV infection. LBM loss of >1 kg occurred in 35% of the cohort, and LBM loss of >5% occurred in 12.2% over 8 mo of observation, but classical wasting (loss of approximately 10% of weight) was rare (2%). Both TNF-alpha (-150 g LBM. ng(-1) x ml(-1), P < 0.02) and IL-1 beta production (-130 g LBM x ng(-1) x ml(-1), P < 0.01) by peripheral blood mononuclear cells predicted loss of LBM. A rise in REE of >200 kcal/day was found in 17.7% of the subjects regardless of weight change. IL-1 beta (+9 kcal/day per ng/ml, P < 0.002) and TNF-alpha (+10 kcal/day per ng/ml, P < 0.02) production predicted Delta REE. Serum free testosterone was inversely associated with TNF-alpha production and was not an independent predictor of either Delta LBM or Delta REE after adjustment for cytokine production. Even though weight loss was rare in this cohort of patients treated with highly active antiretroviral therapy, loss of LBM was common and was driven by catabolic cytokines and not by inadequate dietary intake or hypogonadism.