Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

WASTING IN HIV DISEASE - PROGRESS TOWARDS RATIONAL MANAGEMENT STRATEGY

BG Gazzard
Chelsea & Westminster Hospital, Fulham Road, London

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 11.1
AIDS 1996, Vol. 10 (Suppl. 2);S6

The commonest cause of weight loss in HIV seropositive individuals is infection and by corollary the most effective prevention of weight loss is effective treatment or prophylaxis of such infections.

Asymptomatic HIV seropositive individuals rarely lose weight despite evidence of immunological progression. Sudden episodes of severe weight loss associated with some weight gain subsequently are likely to be due to treatable opportunistic infections while relentless, continuous weight loss is likely to be related to untreatable gastrointestinal infection associated with diarrhoea.

The pathogenesis of weight loss is likely to vary depending on the underlying associated infection. Many asymptomatic HIV seropositive individuals do have a slightly raised resting energy expenditure associated with a normal caloric intake and lean body mass. Fat free mass is slightly reduced but this does not evolve progressively. These changes are likely to be due to the underlying HIV infection and do not result in weight loss because of subtle adjustments in diet and total expenditure. Gastrointestinal infection produces a "starvation" type of weight loss with a preferential loss of fat mass and a reduced resting energy expenditure. Such patients have very low caloric intakes related to anorexia. In contrast systemic infection such as mycobacterium avium intracellular (MAI) and cytomegalovirus infection (CMV) produced a cachexic response with raised resting energy expenditure and loss of lean body mass.

Starvation responses should respond to simple caloric patient, thus appetite stimulants and assisting intake either by naso-gastric or gastrostomy tube feeding all have a role and in people who are able to exercise, moderate increases in lean body mass occur. Parenteral nutrition is also effective but there is an increased risk of sepsis and interference with the quality of life. It is likely that cachectic responses are related to stimulation of the complex cytokine network and, as such, may in the future respond to immunological manipulation although, for the present, effective treatment of the underlying opportunistic infection is the most important therapy. The role of recombinant growth hormone in such patients remains to be defined. It undoubtedly can produce impressive short term gains in lean body mass but is extremely expensive.

Presenting author: BG Gazzard

1996-11-03
11.1

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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