Skip Navigation

Link to  the National Institutes of Health  
The Science of Drug Abuse and Addiction from the National Institute on Drug Abuse Archives of the National Institute on Drug Abuse web site
Go to the Home page

Pathogenesis of and Intervention for Malnutrition in HIV Infection

Donald P. Kotler, M.D.
St. Luke's-Roosevelt Hospital Center
Columbia University College of Physicians and Surgeons

Learning Objectives

  • To review the major pathogenic features underlying malnutrition in HIV infection.

  • To review the studies of nutritional support in HIV infection.


Malnutrition is common in HIV-infection and plays an independent and significant role in its morbidity and mortality. Early studies showed weight loss and evidence of protein depletion, while body composition documented depletion of body cell mass in HIV-infected men, with more prominent losses of fat in women. Malnutrition in HIV infection promotes adverse clinical outcomes, including shortened survival and diminished quality of life. The development of malnutrition is multifactorial, varies as a function of disease stage and disease complications, and includes alterations in intake, absorption, or metabolism. Metabolic abnormalities in HIV-infected individuals include elevations in resting energy expenditure (REE), increased protein turnover in clinically ill patients, alterations in fat metabolism, and hypogonadism. HIV infection itself may promote malnutrition, as body cell mass depletion and elevated REE occur in early-stage subjects, weight loss and REE correlate with plasma viral load, and weight gain may occur during antiretroviral therapy. The relative contributions of the various pathogenic mechanisms is uncertain, though two studies have shown that decreased food intake is the major predictor of weight loss and that total energy expenditure is not elevated in systemic infections associated with weight loss.

Several studies have documented weight gain during nutritional support. Increasing caloric intake by nutritional counseling, nutritional formulae, appetite stimulants, and enteral and parenteral tube feedings all may increase caloric intake and body weight. However, these techniques may fail to lead to body cell mass repletion. For this reason, adjunctive therapies for wasting have been applied, including anabolic agents, cytokine inhibitors, and resistance exercise training. The optimal nutritional support for an HIV-infected individual remains to be determined.


Coodley, G.O.; Loveless, M.O.; Nelson, H.D.; and Coodley, M.K. Endocrine function in the HIV wasting syndrome. J Acq Immunodefic Syndr 7:46-51, 1994.

Grinspoon, S.; Corcoran, C.; Miller, K.; Biller, B.M.K.; Askari, H.; Eang, E.; Hubbard, J.; Anderson, E.J.; Basgoz, N.; Heller, H.M.; and Klibanski, A. Body composition and endocrine function in women with the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 82:1332-1337, 1997.

Grunfeld, C.; Pang, M.; Shimizu, L.; Shigenaga, J.K.; Jensen, P.; and Feingold, K.R. Resting energy expenditure, caloric intake, and short-term weight change in human immunodeficiency virus infection and AIDS. Am J Clin Nutr 55:455-460, 1992.

Grunfeld, C., and Feingold, K.R. Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. N Engl J Med 327:329-337, 1992.

Hommes, M.J.T.; Romijn, J.A.; Godfried, M.H.; Eeftninck Schattenkerk, J.K.M.; Buurman, W.A.; Endert, E.; and Sauerwein, H.P. Increased resting energy expenditure in human immunodeficiency virus-infected men. Metabolism 39:1186-1190, 1990.

Kotler, D.P.; Wang, J.; and Pierson, R.N. Studies of body composition in patients with the acquired immunodeficiency syndrome. Am J Clin Nutr 42:1255-1265, 1985.

Kotler, D.P.; Tierney, A.R.; Wang, J.; and Pierson, R.N., Jr. The magnitude of body cell mass depletion determines the timing of death from wasting in AIDS. Am J Clin Nutr 50:444-447, 1989.

Macallan, D.C.; Noble, C.; Baldwin, C.; Jebb, S.A.; Prentice, A.M.; Coward, W.A.; Sawyer, M.B.; McManus, T.J.; and Griffin, G.E. Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med 333:83-88, 1995.

Ott, M.; Lambke, B.; Fischer, H.; Jagre, R.; Polat, H.; Geier, H.; Rech, M.; Staszeswki, S.; Helm, E.B.; and Caspary, W.F. Early changes of body composition in human immunodeficiency virus-infected patients: Tetrapolar body impedance analysis indicates significant malnutrition. Am J Clin Nutr 57:15-19, 1993.

Schambelan, M.; Mulligan, K.; Grunfeld, C.; Daar, E.S.; Lamarca, A.; Kotler, D.P.; Wang, J.; Bozzette, S.A.; and Breitmeyer, J.B. Recombinant human growth hormone in patients with HIV-associated wasting. Ann Intern Med 125:873-882, 1996.

[Cover Page][Abstracts][Agenda][Speaker List]

Archive Home | Accessibility | Privacy | FOIA (NIH) | Current NIDA Home Page
National Institutes of Health logo_Department of Health and Human Services Logo The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. . The U.S. government's official web portal