[P-24] Resting energy expenditure and substrate utilization in AIDS patients with lipodystrophy syndrome

10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

6-8 November 2008, London, UK

RESTING ENERGY EXPENDITURE AND SUBSTRATE UTILIZATION IN AIDS PATIENTS WITH LIPODYSTROPHY SYNDROME

Antiviral Therapy 2008; 13(Suppl. 4):A39 (abstract no. P-24)

HS Vassimon¹, AA Jordão Jr¹, AA Machado¹, FJA Paula¹ and JP Monteiro²
¹Departamentos de Clínica Médica da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil; ²Puericultura e Pediatria da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil

AIM: AIDS patients with lipodystrophy syndrome (LS) may have increased resting energy expenditure and altered macronutrient metabolism. The objective of this study was to describe substrate utilization and the resting energy expenditure (REE) in AIDS patients with and without LS and in health-control men.

METHODS: It was a cross-sectional study with 44 male patients, who were divided into three groups: 10 AIDS patients receiving highly active antiretroviral therapy (HAART) and with LS (HIV+LIP+), 22 AIDS patients receiving HAART and without LS (HIV+LIP-) and 12 health-control men (HC). Body composition was evaluated by dual-energy X-ray absorptiometry. REE was measured by indirect calorimetry after 12 h overnight fast and macronutrient utilization was also determined by respiratory quocient. Statistical analyses were performed using ANOVA and Tukey post test.

RESULTS: AIDS patients were clinically stable and had similar CD4 cell count, age and body mass index (BMI). The duration of HIV infection and the duration of HAART (Table 1) were similar among the patients. The HIV+LIP+ group showed less total body fat when compared with controls. Leg lipoatrophy was most evident in HIV+LIP+ patients. Although REE was similar among groups, when we adjusted for lean body mass (LBM; ratios of REE per kg LBM), which is known to be the major determinant of energy expenditure, we noticed that this ratio was significantly greater in HIV+LIP+ than the other two groups (HIV+LIP+ 37 ±1.2, HIV+LIP- 34 ±0.79 and HC 32 ±1.2 kcal/kg LBM, P=0.02). In addition to higher REE, we also found a significantly higher respiratory quotient (RQ) in HIV+LIP+ and HIV+LIP- when compared with HC (HIV+LIP+ 0.90 ±0.03, HIV+LIP- 0.89 ±0.08 and HC 0.82 ±0.058, P=0.001).

Table 1. Demographic and nutritional data of AIDS patients with lipodystrophy (HIV+LIP+), without lipodystrophy (HIV+LIP-) and health control men (HC; Abstact P-24)

	HIV+LIP+	HIV+LIP	HC	P-value

Age, years	46 ±5	43 ±6	45 ±5	0.246
Body mass index, kg/m²	24 ±3	24±3	26 ±3	0.112
Duration of HIV infection, months	114 ±27	96 ±64	0	0.43
Duration of HAART, months	110 ±23	78 ±52	0	0.10
CD4 cell count, ×10⁶/l	574 ±300	445 ±186	0	0.18
Total body fat mass, %	17 ±5*	20 ±6	24 ±4	0.014
Total leg fat mass, %	10 ±5†	17 ±7	22 ±7	<0.001

*Statistically different from HC. †HIV+LIP+ is statistically different from HIV+LIP- and HC. HAART, highly active antiretroviral therapy.

CONCLUSIONS: Lipodystrophy syndrome could, independently, be a determinant of high energy expenditure in HIV patients. Also HIV patients with or without LS have a higher carboydrate utilization.

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2008-11-06
P-24

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