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Clinical heterogeneity for metabolic and nutritional measures in AIDS-wasting syndrome (AWS) compared to HIV-negative controls.




 

Int Conf AIDS. 1996 Jul 7-12;11(2):20 (abstract no. We.B.183). Unique

Published data concerning metabolic alterations contributing to AWS have been contradictory. This may reflect differences among clinical populations (i.e. heterogeneity). We have compiled 6 yr of baseline metabolic/nutritional data in AWS prior to interventions (n= 170 men, 37 women). Weight (wt), body composition, dietary intake (3-7d records), hormone and metabolite concentrations and stable isotope/mass spectrometric kinetic measures of metabolism (by isotope dilution or mass isotopomer methods) are reported here. Mean plus or minus S.D. values and variability (% subjects clustered in discrete intervals) are compared in AWS vs HIV-negative controls (Ctrl). Results: In AWS, wt loss=9.3 plus or minus 6.1kg (mean plus or minus S.D.) (11.8 plus or minus 10.3% usual wt), serum triglycerides = 182 plus or minus 135 and cholesterol (c) = 143 plus or minus 41mg/dl. Total testosterone, AWS (n=41)= 481 plus or minus 209 ng/dl vs Ctrl (36) 621 plus or minus 213. Resting energy expenditure = 113 plus or minus 11% predicted; Intake = 97 plus or minus 29% required kCal/d. Kinetic measures: fasted hepatic de novo lipogenesis (DNL), in AWS (n = 73) = 3.8 plus or minus 3.7% (49% less than 3.0%) vs Ctrl (n=43) = 1.8 plus or minus 1.3% (85% less than 3.0%). Fed DNL, AWS (n = 61) = 7.9 plus or minus 6.0% (1/4 less than 3.0, 1/4 = 3-6, 1/3 greater than 9.0) vs Ctrl (31) = 3.3 plus or minus 2.7% (49% less than 3.0; 50% = 3-6). Fasted C synthesis, AWS (23) = 2.3 plus or minus 2.2% vs Ctrl (10) = 1.8 plus or minus 0.2%. Rate of appearance (Ra) of glycerol (micromolar/kg/m), AWS (18) = 1.9 plus or minus 1.3 (30% = 0-1, 30% = 1-2, 30% = 2-3) vs Ctrl (7) = 1.5 plus or minus 0.4 90% = 1-2). Ra free fatty acids (FFA) (micromolar/kg/m), AWS 15) = 3.3 plus or minus 1.3 (50% = 1.5-3.0) vs Ctrl (33) = 2.6 plus or minus 0.9 (78% = 1.5-3.0). FFA concentrations micrometer), AWS (28) = 395 plus or minus 152 vs Ctrl (10) = 363 plus or minus 84. Ra glucose (mg/kg/m), AWS (28) = 2.6 plus or minus 1.1 (21%=1.7-2.6) vs Ctrl (27) = 2.3 plus or minus 0.9 (73% = 1.7-2.6). Conclusions: (1) AWS exhibit abnormalities of average group) values for many kinetic, biochemical and anatomic parameters vs Ctrls; (2) Moreover, much greater variability is present in AWS population vs Ctrls; (3) DNL fed exhibits particular heterogenicity; (4) Heterogeneity maybe useful for patient classification and stratification in therapeutic studies; 5) Internal correlations in data set reveal likely mechanisms e.g. low C concentration not due to decreased C synthesis; Fed DNL compared to fasted suggests cytokines, not carbohydrate surplus); (6) Heterogeneity may explain inconsistencies in the literature.

*Acquired Immunodeficiency Syndrome/METABOLISM *Cachexia/METABOLISM *Nutrition Assessment



 




Information in this article was accurate in January 30, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.