Effect of indinavir on HIV-related wasting.
OBJECTIVE
To study the effect of the protease inhibitor indinavir on body weight and body composition of subjects with HIV-related wasting.


METHODS
Prospective measurement of body weight in patients who had wasting and were treated with indinavir. A subgroup of 16 representative patients also underwent a metabolic study that included measurements of body composition (skinfolds and bioelectrical impedance) and food intake. Seven from this subgroup who did not have chronic diarrhoea also underwent indirect calorimetry for measurement of resting energy expenditure; the nine patients with wasting and chronic diarrhoea had measurements of faecal losses and intestinal permeability using the lactulose-mannitol test.


METHODS
A tertiary care university hospital.


METHODS
Two hundred and fourteen HIV-infected patients with wasting (less than 95% of usual body weight) had their body weight measured at day 0; 186 patients had a second body weight measurement within the first 100 days of treatment, and 160 patients were weighed a third time, at a median of 176 days.


RESULTS
Body weight increased significantly (P < 0.0001) during treatment, whatever the degree of weight loss at baseline. After a median of 176 days on treatment, body weight had increased in 119 out of the 160 patients followed (74.4%; mean weight gain, 6.3+/-SD 3.8 kg; range, 1-18 kg), had not changed in 13 (8.1%) and had fallen in 28 (17.5%; mean weight loss, 4.2+/-3.0 kg; range, 1-12 kg), relative to baseline. Overall, 119 out of the 214 patients (55.6%) from the initial population gained weight. Fat mass, fat-free mass and body cell mass increased significantly in the 16 patients who underwent metabolic studies, together with energy, protein and lipid intake. In the patients with chronic diarrhoea, intestinal permeability improved but there was no change in intestinal losses. In patients who had wasting but not chronic diarrhoea, resting energy expenditure did not change significantly. Body weight changes correlated with changes in the CD4+ cell count (r = 0.882; P = 0.00001) and, to a lesser extent, with changes in the viral load (r = -0.466; P = 0.047).


CONCLUSIONS
Indinavir significantly improved the nutritional status of these patients with HIV-related wasting.
Carbonnel
F
F
Service de Gastroentérologie et de Nutrition, Hôpital Rothschild, Paris, France.
Maslo
C
C
Beaugerie
L
L
Carrat
F
F
Wirbel
E
E
Aussel
C
C
Gobert
J G
JG
Girard
P M
PM
Gendre
J P
JP
Cosnes
J
J
Rozenbaum
W
W
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004435:Eating / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D019247:HIV Wasting Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000821:virology; D006785:Hospitals, University; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D019469:Indinavir