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Changes in Weight and Body Composition Among HIV+ Substance-Using African-American and Latino Men and Women


Sai Subhasree Raghavan, Ph.D.
Harlem Hospital Center and Columbia University College of Physicians and Surgeons


Lecture Outline

  1. Prevalence and predictors of wasting among HIV+ substance users.

  2. Comparison of body composition among substance-using and non-substance-using HIV+ and HIV- individuals.

  3. Gender differences in body composition between HIV+ substance- and non-substance- using individuals.

  4. Comparison of longitudinal changes in weight and body composition among HIV+ substance-using and non-substance-using individuals, pre-HAART and post-HAART era.

  5. Impact of substance use on weight gain during pregnancy and its effect on infant outcome in HIV+ and HIV- women.

  6. Incidence of HAART-related metabolic complications among substance-using and non- substance-using individuals.

  7. Special issues and ethical dilemmas in treatment of nutritional problems among substance users.

Learning Objectives

  • To learn the impact of substance use on weight and body composition among HIV+ individuals.

  • To learn to differentiate substance-use-associated wasting from that of HIV-associated wasting.

Abstracts

Substance use plays a central role in HIV infection, accounting for one-third of the HIV-infected cases and accounting directly or indirectly for 80% of AIDS cases in women in the United States. Nutrient deficiencies are common in substance-using individuals due to increased nutrient needs, compromised liver and kidney activation of vitamins and coenzymes, poor or haphazard nutrient intake, increased catabolism and hyperexcretion, reduced liver storage, malabsorption and malutilization, and drug inactivation of vitamins. It is well documented that use of drugs such as heroin, cocaine, and marijuana affects food and liquid intake behavior, which in turn will result in development of malignant and infectious complications. Malnutrition due to inadequate food intake can impair immunity and, thus, influence susceptibility to infectious agents, including HIV. Despite two decades of research on AIDS- associated wasting, limited information is available on the prevalence, pathophysiology, and treatment of nutritional deficiencies among drug users.

We conducted several studies to answer a few of these crucial questions. One such study will examine the changes in weight and body composition among drug-using and non-drug-using HIV+ men and women to differentiate the impact of substance use from that of HIV. Additional studies that will be discussed include the impact of substance use on weight gain during pregnancy in HIV+ women and the incidence of metabolic complications among substance-using and non-substance-using HIV+ individuals on HAART therapy.

References

Alcabes P and Friedland G, Injection drug use and Human Immunodeficiency Virus Infection, Clinical Infectious Diseases, 1995;20:1467-79.

Mohs ME, Watson RR, Leonard-Green T, Nutritional effects of Marijuana, heroin, cocaine and nicotine, J. Am. Diet Assoc 1990; 90: 1216-7.

Altes J, Dolz C, Obrador A, Forteza-Rei J. Prevalence of protein-energy malnutrition in heroin addicts hospitalized for detoxification. J Clin Nutr Gastroenterology 1988; 68:519-31.

Mosenson M, Zeleniuch-Jacquotte A, Belsito DV, Shore RE, Marmor M, Pasternack B. The potential role of nutritional factors in the induction of immunological abnormalities in HIV-positive homosexual men. J Acquir Immune Defic Syndrome 1989; 2:235-47.

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