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Nutritional Disorders in a Cohort of Persons with HIV/AIDS Including Drug Abusers


Janet E. Forrester, Ph.D., and Sherwood L. Gorbach, M.D.
Tufts University School of Medicine


Lecture Outline

  1. Expected body composition changes in normal males losing weight due to caloric restriction.

  2. Body composition in relation to CD4 counts in HIV disease.

  3. Body composition in relation to drug abuse in persons with HIV.

  4. Micronutrient intake in relation to drug abuse in persons with HIV.

Learning Objectives

  • What nutritional deficiencies are found in drug abusers?

  • What changes in body composition occur in persons who abuse drugs?

  • What changes in body composition occur in persons who have HIV and abuse drugs?

  • How does drug abuse affect the outcome of disease in HIV, and is this related to changes in nutritional status due to drug abuse?

Abstract

The changes in body composition that occur in HIV disease are controversial. HIV wasting has alternately been found to be predominantly a loss of lean body mass (1,2) or a predominance of fat loss (3,4). We examined body composition in relation to CD4 counts in a cross-sectional analysis of the baseline data from the first 516 enrollees in the Nutrition for Life cohort, a 3-year longitudinal study of HIV and nutrition. Weight was stable above 600 CD4 counts and declined linearly thereafter at a rate of 1.9 kg per 100 decline in CD4 cells (p<0.0001). Below 600 CD4 cells, fat mass declined at a rate of 1.5 kg (p<0.0001), and lean body mass at a rate of 0.45 kg (p=0.026) per 100 CD4 cells. However, loss of lean body mass was dependent on percent body fat: In males with less than 15% and females with less than 23% body fat, loss of lean body mass was negatively associated with percent body fat. Loss of lean body mass was not associated with body fat at levels above 15% in males and 23% in females. Our results suggest that in persons with adequate fat stores, loss of weight with disease progression is predominantly fat, while in persons with low fat stores, a higher proportion of the weight lost is lean body mass, and that the amount of lean body mass lost depends on the percent body fat. We also present preliminary data on body composition and nutrient intake in drug abusers.

References

Kotler, DP, Wang J Pierson RN Am J Clin Nutr. 1985; 42: 1255-1265. Body composition studies in patients with the acquired immunodeficiency syndrome .

Paton NIJ, Macallan DC, Jebb SA et al. Longitudinal changes in body composition measured with a variety of methods in patients with AIDS. J Acquir Immune Defic Syndr. 1997; 14: 119-127.

Schwenk A, Hoffer-Belitz E, Jung B et al. Resting energy expenditure, weight loss and altered body composition in HIV infection. Nutrition 1996; 12: 595-601.

Mulligan K, Tai VW and Schamblean M. Cross-sectional and longitudinal evaluation of body composition in men with HIV. J Acquir Immune Defic Syndr 1997; 15: 43-48.

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