The effect of protease inhibitors on weight and body composition in HIV-infected patients.
OBJECTIVE
To determine the nutritional changes that occur in HIV-infected patients receiving protease inhibitor (PI) therapy and to determine the effects of PI treatment on physical functioning and health perceptions in patients with HIV infection.


METHODS
Longitudinal data analysis of 38 patients from a large Nutrition and HIV cohort.


METHODS
Patients were included if they had started PI therapy after enrollment in the cohort, if they had taken the drug for at least 4 months without interruption and if data on weight, body composition and viral loads were available.


RESULTS
Mean person-months of follow-up was 8.1 months before and 12.2 months after PI treatment. Weight (1.54 kg, P < 0.0001), body mass index (0.50 kg/m2, P < 0.0001), physical functioning (8.52 points, P = 0.0006) and current health perception (6.7 points, P = 0.01) increased significantly, and the daily caloric intake increase was close to significance (915.5 kJ/day, P = 0.06), after treatment with PI. Lean body mass did not change. Patients who responded to PI therapy with decreased viral load (n = 28) had significantly greater weight gain per month than non-responders.


CONCLUSIONS
PI therapy of HIV infection is associated with weight gain and improvement in quality of life indices. The weight gain is mainly in fat mass, with no change in lean body mass (skeletal muscle). Optimal therapy of HIV-infected patients with weight loss may require highly active antiretroviral therapy combined with an anabolic stimulus such as exercise, anabolic steroids or human growth hormone.
Silva
M
M
Department of Community Health, Tufts University School of Medicine, and the New England Medical Center Hospitals, Boston, Massachusetts 02111, USA.
Skolnik
P R
PR
Gorbach
S L
SL
Spiegelman
D
D
Wilson
I B
IB
Fernández-DiFranco
M G
MG
Knox
T A
TA
D000328:Adult; D001823:Body Composition / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects*; D019438:Ritonavir / Q000627:therapeutic use; D019258:Saquinavir / Q000627:therapeutic use; D019562:Viral Load
D017320:HIV Protease Inhibitors; D019469:Indinavir; D019258:Saquinavir; D019438:Ritonavir