Infection with human immunodeficiency virus (HIV) is associated with marked disturbance of metabolism affecting the metabolism of carbohydrates, fats and proteins. In the first decade of clinical experience of HIV, the primary clinical manifestation of such disturbed metabolism was wasting. Such wasting was often severe and contributed significantly to the morbidity and mortality of AIDS. Mechanistic studies demonstrated that in addition to the effects of altered intermediary metabolism, reduced food intake played a major role in the causation of AIDS-related wasting. More recently, potent anti-retroviral drugs have dramatically changed the clinical consequences of HIV infection. Wasting has become far less frequent among infected patients and occurs in only a small percentage of subjects on effective anti-retroviral therapy. However, a new constellation of metabolic syndromes has become apparent characterized by altered body fat distribution (‘lipodystrophy’), lactic acidosis and evidence of mitochondrial dysfunction. The mechanistic basis for such syndromes is currently unclear, but is the subject of ongoing research.

Keywords:
HIV, AIDS, Metabolism, Nutrition, Wasting, Lipodystrophy, Growth hormone
1.
Kotler DP, Tierney AR, Wang J, Pierson RN: Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr 1989;50:444–447.
2.
Wheeler DA, Gibert CL, Launer CA, Muurahainen N, Elion RA, Abrams DI, Bartsch GE: Weight loss as a predictor of survival and disease progression in HIV infection. Terry Beirn Community Programs for Clinical Research on AIDS. J Acquir Immune Defic Syndr 1998;18:80–85.
3.
Mulligan K, Tai VW, Schambelan M: Energy expenditure in human immunodeficiency virus infection. N Engl J Med 1997;336:70–71.
4.
Grinspoon S, Corcoran C, Miller K, Wang E, Hubbard J, Schoenfeld D, Anderson E, Basgoz N, Klibanski A: Determinants of increased energy expenditure in HIV-infected women. Am J Clin Nutr 1998;68:720–725.
5.
Macallan DC, McNurlan MA, Milne E, Calder AG, Garlick PJ, Griffin GE: Whole body protein turnover from leucine kinetics and the response to nutrition in human immunodeficiency virus infection. Am J Clin Nutr 1995;61:818–826.
6.
Macallan DC: Metabolic abnormalities and wasting in human immunodeficiency virus infection. Proc Nut Soc 1998;57:373–380.
7.
Macallan DC, McNurlan MA, Kurpad AV, De Souza G, Shetty PS, Calder AG, Griffin GE: Whole body protein metabolism in human pulmonary tuberculosis and undernutrition: Evidence for anabolic block in tuberculosis. Clin Sci 1998;94:321–331.
8.
Grunfeld C, Kotler DP, Hamadeh R, Tierney AR, Wang J, Pierson RN: Hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med 1989;86:27–31.
9.
Grunfeld C, Pang M, Doerrler W, Shigenaga JK, Jensen P, Feingold KR: Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1992;74:1045–1052.
10.
Hellerstein MK, Grunfeld C, Wu K, Christiansen M, Kaempfer S, Kletke C, Shackleton CHL: Increased de novo hepatic lipogenesis in human immunodeficiency virus infection. J Clin Endocrinol Metab 1993;76:559–565.
11.
Macallan DC, Noble C, Baldwin C, Jebb SA, Prentice AM, Coward WA, Sawyer MB, McManus TJ, Griffin GE: Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med 1995;333:83–88.
12.
Sheehan LA, Macallan DC: Determinants of energy intake and energy expenditure in HIV and AIDS. Nutrition 2000;16:101–106.
13.
Kotler DP, Tierney AR, Culpepper-Morgan JA, Wang J, Pierson RN: Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome. J Parenteral Enteral Nutr 1990;14:454–458.
14.
Suttmann U, Ockenga J, Selberg O, Hoogestraat L, Deicher H, Muller MJ: Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquir Immune Defic Syndr 1995;8:239–246.
15.
Mulligan K, Grunfeld C, Hellerstein MK, Neese RA, Schambelan M: Anabolic effects of recombinant human growth hormone in patients with wasting associated with human immunodeficiency virus infection. J Clin Endocrinol Metab 1993;77:956–962.
16.
Waters D, Danska J, Hardy K, Koster F, Qualls C, Nickell D, Nightingale S, Gesundheit N, Watson D, Schade D: Recombinant human growth hormone, insulin-like growth factor 1, and combination therapy in AIDS-associated wasting. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996;125:865–872.
17.
Mulligan K, Tai VW, Schambelan M: Use of growth hormone and other anabolic agents in AIDS wasting. J Parenter Enteral Nutr 1999;23(suppl 6):S202–S209.
18.
Schambelan M, Mulligan K, Grunfeld C, Daar ES, LaMarca A, Kotler DP, Wang J, Bozzette SA, Breitmeyer JB: Recombinant human growth hormone in patients with HIV-associated wasting. A randomized, placebo-controlled trial. Ann Intern Med 1996;125:873–882.
19.
Paton NIJ, Newton PJ, Sharpstone DR, Ross HM, Cotton J, Calder AG, Milne E, Elia M, Shah S, Engrand P, et al: Short-term growth hormone administration at the time of opportunistic infections in HIV-positive patients. AIDS 1999;13:1195–1202.
20.
Lucas SB, De Cock KM, Hounnou A, Peacock C, Diomande M, Honde M, Beaumel A, Kestens L, Kadio A: Contribution of tuberculosis to slim disease in Africa. Br Med J 1994;308:1531–1533.
21.
Safrin S, Grunfeld C: Fat distribution and metabolic changes in patients with HIV infection. AIDS 1999;13:2493–2505.
22.
Sullivan AK, Feher MD, Nelson MR, Gazzard BG: Marked hypertriglyceridaemia associated with ritonavir therapy. AIDS 1998;12:1393–1394.
23.
Blanche S, Tardieu M, Rustin P, Slama A, Barret B, Firtion G, Ciraru-Vigneron N, Lacroix C, Rouzioux C, Mandelbrot L, et al: Persistent mitochondrial dysfunction and perinatal exposure to antiretroviral nucleoside analogues. Lancet 1999;354:1084–1089.
24.
Thoni G, Reynes J, Mercier J, et al: Do lipoatrophic HIV1-infected patients present the same metabolic abnormalities as those with abdominal fat accumulation? Proceedings of the XIII International AIDS Conference 2000; abstract ThOrB757.
25.
Lo JC, Mulligan K, Tai VW, Algren H, Schambelan M: ‘Buffalo hump’ in men with HIV-1 infection. Lancet 1998;35:1867–1870.
26.
Christeff N, Melchior JC, de Truchis P, Perronne C, Nunez EA, Gougeon ML: Lipodystrophy defined by a clinical score in HIV-infected men on highly active antiretroviral therapy: Correlation between dyslipidaemia and steroid hormone alterations. AIDS 1999;13:2251–2260.
27.
Palella FJJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338:853–860.
28.
Engelson ES, Kotler DP, Tan Y, Agin D, Wang J, Pierson RNJ, Heymsfield SB: Fat distribution in HIV-infected patients reporting truncal enlargement quantified by whole-body magnetic resonance imaging. Am J Clin Nutr 1999;69:1162–1169.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.