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The metabolic response to opportunistic infections in AIDS
D R Sharpstone1, H M Ross, B G Gazzard
1Department of HIV/Genito-Urinary Medicine, Chelsea and Westminster Hospital, London, UK.
Objective:
The metabolic response to AIDS-defining opportunistic infections was examined to provide a logical basis for the management of associated weight loss.
Design:
A prospective study of metabolism in AIDS.
Setting:
HIV outpatients' department and wards at the Chelsea and Westminster Hospital, London.
Patients:
Ten asymptomatic Centers for Disease Control and Prevention stage II HIV-seropositive control subjects and 36 HIV-seropositive patients with a single newly diagnosed and untreated opportunistic infection [10 with microsporidial or cryptosporidial diarrhoea, 10 with Pneumocystis carinii pneumonia, nine with cytomegalovirus enteritis and seven with systemic Mycobacterium avium-intracellulare].
Main Outcome Measurements:
Subjects had measurements of resting energy expenditure using indirect calorimetry and of body composition using dual energy X-ray absorptiometry.
Results:
Subjects with protozoal diarrhoea had a decreased resting energy expenditure (P < 0.05) and decreased body fat (P < 0.01). Subjects with P. carinii pneumonia had an elevated resting energy expenditure (P < 0.05). Subjects with systemic M. avium-intracellulare had an elevated resting energy expenditure (P < 0.05) and decreased skeletal muscle mass (P < 0.05). Subjects with cytomegalovirus enteritis had a non-significant elevation of resting energy expenditure with a non-significant loss of both fat and lean tissue.
Conclusion:
Subjects with protozoal diarrhoea show a starvation response to infection and subjects with systemic M. avium-intracellulare show a cachectic response. Since there is a variation in the metabolic response to opportunistic infection in AIDS patients, nutritional management should be directed according to the specific cause.
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