The metabolic response to opportunistic infections in AIDS.
OBJECTIVE
The metabolic response to AIDS-defining opportunistic infections was examined to provide a logical basis for the management of associated weight loss.


METHODS
A prospective study of metabolism in AIDS.


METHODS
HIV outpatients' department and wards at the Chelsea and Westminster Hospital, London.


METHODS
Ten asymptomatic Centers for Disease Control and Prevention stage II HIV-seropositive control subjects and 36 HIV-seropositive patients with a single newly diagnosed and untreated opportunistic infection [10 with microsporidial or cryptosporidial diarrhoea, 10 with Pneumocystis carinii pneumonia, nine with cytomegalovirus enteritis and seven with systemic Mycobacterium avium-intracellulare].


METHODS
Subjects had measurements of resting energy expenditure using indirect calorimetry and of body composition using dual energy X-ray absorptiometry.


RESULTS
Subjects with protozoal diarrhoea had a decreased resting energy expenditure (P < 0.05) and decreased body fat (P < 0.01). Subjects with P. carinii pneumonia had an elevated resting energy expenditure (P < 0.05). Subjects with systemic M. avium-intracellulare had an elevated resting energy expenditure (P < 0.05) and decreased skeletal muscle mass (P < 0.05). Subjects with cytomegalovirus enteritis had a non-significant elevation of resting energy expenditure with a non-significant loss of both fat and lean tissue.


CONCLUSIONS
Subjects with protozoal diarrhoea show a starvation response to infection and subjects with systemic M. avium-intracellulare show a cachectic response. Since there is a variation in the metabolic response to opportunistic infection in AIDS patients, nutritional management should be directed according to the specific cause.
Sharpstone
D R
DR
Department of HIV/Genito-Urinary Medicine, Chelsea and Westminster Hospital, London, UK.
Ross
H M
HM
Gazzard
B G
BG
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000378:metabolism*; D001823:Body Composition; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D003457:Cryptosporidiosis / Q000276:immunology / Q000378:metabolism*; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000378:metabolism*; D003967:Diarrhea / Q000276:immunology / Q000378:metabolism*; D004734:Energy Metabolism; D006801:Humans; D008297:Male; D016881:Microsporidiosis / Q000276:immunology / Q000378:metabolism*; D015270:Mycobacterium avium-intracellulare Infection / Q000276:immunology / Q000378:metabolism*; D011020:Pneumonia, Pneumocystis / Q000276:immunology / Q000378:metabolism*; D011446:Prospective Studies