Bioelectrical impedance analysis in HIV-infected patients treated with triple antiretroviral treatment.
BACKGROUND
Triple antiretroviral treatment including protease inhibitors (PIs) delays the clinical progression of HIV infection and may thus reduce the risk of malnutrition. However, fat redistribution (lipodystrophy) was recognized recently as a metabolic side effect of PIs.


OBJECTIVE
The study aimed to assess the effect of triple antiretroviral treatment on body composition and on the prevalence of malnutrition.


METHODS
Two cross-sectional studies, 1 in 1996 (t96; n = 247) and 1 in 1997 (t97; n = 266), were conducted in HIV-infected outpatients. Among patients who participated in both studies, 111 patients started a new antiretroviral treatment including a PI between t96 and t97 and were studied longitudinally. Total body water (TBW), intracellular water (ICW), extracellular water (ECW), and fat mass were estimated by monofrequency bioelectrical impedance analysis (BIA).


RESULTS
Prevalence of malnutrition was reduced by 30-50% from t96 to t97, depending on the definition used. In the longitudinal study, TBW and the ratio between ICW and ECW increased and fat mass decreased (P < 0.001). BIA indicated a greater increase in ICW in 23 (21%) patients with clinically apparent fat redistribution than in patients without this syndrome, but estimates of fat mass changes were not significantly different.


CONCLUSIONS
Triple antiretroviral treatment may protect HIV-infected patients against the development of malnutrition. Whole-body BIA data suggest an increase in appendicular body cell mass associated with improved antiretroviral treatment. However, the method is unreliable in detecting fat redistribution, and current prediction equations will need to be recalibrated for HIV-infected patients receiving highly active antiretroviral treatment.
Schwenk
A
A
Department of Internal Medicine, University of Cologne, Germany. a.schwenk@sghms.ac.uk
Beisenherz
A
A
Kremer
G
G
Diehl
V
V
Salzberger
B
B
Fätkenheuer
G
G
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001823:Body Composition / Q000187:drug effects*; D001834:Body Water / Q000187:drug effects; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced; D008137:Longitudinal Studies; D009748:Nutrition Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009752:Nutritional Status; D015995:Prevalence; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019282:Wasting Syndrome / Q000378:metabolism; D015431:Weight Loss
D019380:Anti-HIV Agents; D011480:Protease Inhibitors