Sierra MJG, López ZJL

Language: Spanish
References: 28
Page: 24-28
PDF size: 84.98 Kb.

ABSTRACT

Weakening syndrome has been a frequent characteristic of patients infected by HIV and being in an advanced state. The use of highly active antiretroviral treatment (HAART) has presented a significant impact on AIDS evolution. HAART produces immunological reconstitution on patients suffering from an advanced state of this disease through its suppressive effect on virus reproduction. HAART has been associated with very important nutritional and metabolic effects which are described in this article. About glucose metabolism, it has been demonstrated that there is a hyperglycemia development in a high percentage of patients receiving protease inhibitors. In total corporal composition, several abnormal fat accumulation syndromes have been described, such as dorsal hump formation, benign symmetric lipoma, abdomen volume increase and mammary gland growth.
Subcutaneous fat loss in face and extremities has also been described, which has been called lipodystrophy. In a study being carried out in the National Institute of Medical Sciences and Nutrition “Salvador Zubirán” it was found that bodyweight increase observed with HAART and including protease inhibitors is mainly due to body fat. Basal metabolism, which is very heterogeneous before beginning the treatment, tend to get normal with the use of HAART.

REFERENCES

1. CDC. Update on acquired immune deficiency syndrome (AIDS ) – United States. MMWR 1982;31:507-14.

2. Gorbach SL, Knox TA, Roubenoff R. Interactions between nutrition and infection with human immunodeficiency virus. Nutr Rev 1993;51:226-34.

3. Babgaleh BT, Tollefson DVM. Nutrition: A cofactor in HIV disease. J Am Diet Assoc 1994;94:1019-22.

4. Keusch GT, Thea DM. Malnutrition in AIDS. Gastr Clin North Am 1993;77:795-814.

5. Babameto G, Kotler DP. Malnutrition in HIV infection. Med Clin North Am 1997;26:393-415.

6. Argiles JP, López-Soriano J, Busquets S, López-Soriano FJ. Journey from cachexia to obesity by TNF. FASEB J 1997;11:743-75.

7. Moldawer LL, Satter FR. Human Immunodeficiency Virus-Associated Wasting and Mechanisms of cachexia associated with inflammation. Sem Oncol 1998;25:S73-S81.

8. Kotler DP, Tierney AR, Wang J, Pierson RN. Magnitude of body-cell mass depletion and the timming of death from wasting in AIDS. Am J Clin Nutr 1989;50:444-47.

9. Strawford A, Hellerstein M. The etiology of wasting in the human immunodeficiency virus and acquired immunodeficiency syndrome. Sem Oncol 1998;25:S76-S81.

10. Hirschel B, Opravil M. The year in review: antiretroviral treatment. AIDS 1999;13:S177-S187.

11. Lundgren J, Masur H. New approaches to managing opportunistic infections. AIDS 1999; 13:S227-S234.

12. Pallela FJ, Delaney KM, Mosrman AC et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. N Engl J Med 1998;338:853-60.

13. Hellerstein MK, Kahn J, Mudie H, Vileri F. Current approach to the treatment of human immunodeficiency virus-associated weight loss: pathophysiologic considerations and emergency management strategies. Semin Oncol 1990;17:17-33.

14. Corcoran C, Grinspoon S. Treatments for wasting in patients with the Acquired Immunodeficiency syndrome. N Engl J Med 1999;340:1740-1750.

15. Viraben R, Aquilina C. Indinavir - associated lipodystrophy. AIDS 1998;12:F37-F39.

16. Carr A, Samaras K, Burtom S et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998;12:F51-F58.

17. Lumpkin MM. Reports of diabetes and hyperglycemia in patients receiving protease inhibitors for the treatment of Human Immunodeficiency virus. Washington DC, FDA Public Health Advisory, 1997; June 11.

18. Carr A, Samaras K, Thorisdotthr A, Kaufmann GR, Chisholm D, Cooper DA. Diagnosis, predictions, and natural course of HIV-1 protease inhibitor associated lipodystrophy, hyperlipidaemia and diabetes mellitus, a cohort study. Lancet 1999;353:2093-99.

19. Chirsteff N, Melchoir JC, De Truchis E, Perronne C, Nunez EA, Gougeun 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.

20. Melchoir JC, Salmon D, Rigaud D et al. Resting energy expenditure is increased in stable, malnourished HIV-infected patients. Am J Clin Nutr 1991; 53:437-441.

21. Hommes MJT, Romijn JA, Endert E, Saverwein HP. Resting energy expenditure and subtrate oxidation in human immunodeficiency virus (HIV)-infected asymptomatic men: HIV affects host metabolism in the early asymptomatic stage. Am J Clin Nutr 1991; 54:311-15.

22. Grunfeld C, Pang M, Shimizu L, Shigenaga JK, Jensen P, Feingold KR. Resting energy expenditure, caloric intake, and short term weight change in human immunodeficiency syndrome. Am J Clin Nutr 1992;55:455-60.

23. Suttman J, Ockenga SU, Hoogestratt L et al. Resting energy expenditure and weight loss in human immunodeficiency virus-infected patients. Metabolism 1993;42:1173-1179.

24. Macallan DC, Noble C, Baldwin C et al. Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med 1995;333:83-88.

25. Mulligan K, Tai VW, Schambelan M. Energy expenditure in Human Immunodeficiency Virus Infection N Engl J Med 1997;336:70-71.

26. Mulligan K, Bloch AS. Energy expenditure and protein metabolism in Human Immunodeficiency virus Infection and cancer cachexia. Sem Oncol 1998;25:82-91.

27. Shevitz AH, Knox TA, Spiegelman D, Roubenoff R, Gorbach SL, Snolnik PR. Elevated resting energy expenditure among HIV seropositive persons receiving highly active antiretroviral therapy. AIDS 1999;13:1351-57.

28. Doming P, Matias-Guiu X, Pujol RM et al. Subcutaneous adipocyte apoptosis in HIV-1 protease inhibitor-associated lipodystrophy. AIDS 1999;13:2261-2267.