translation agency

NLM AIDSLINE
Clinical heterogeneity for metabolic and nutritional measures in AIDS-wasting syndrome (AWS) compared to HIV-negative controls.
Strawford A; Neese R; Hoh R; Pelfini A; Turner S; Papageorgopoulos C;
January 30, 1997
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

www.aegis.org