Beneficial effects of protease inhibitors on body composition and energy expenditure: a comparison between HIV-infected and AIDS patients.
OBJECTIVE
(i) To investigate whether protease inhibitor (PI) (nelfinavir)-containing highly active antiretroviral therapy (HAART) affects body composition differently in HIV-infected and AIDS patients without wasting syndrome. (ii) To delineate the changes in resting energy expenditure (REE) under PI therapy, and to determine whether sustained reductions in HIV RNA would decrease REE.


METHODS
Prospective longitudinal cohort study with individually matched healthy controls.


METHODS
Tertiary care centre at a University Hospital.


METHODS
HIV-seropositive (n = 20) and AIDS patients (n = 17) with a plasma viral load of at least 10000 copies/ml and 37 healthy volunteers were enrolled. All participants were weight stable, free of acute opportunistic infections, and naive to PI therapy. Patients underwent testing of bioelectrical impedance analysis (BIA), indirect calorimetry and food intake, shortly before the initiation of HAART and 24 weeks thereafter.


RESULTS
Both patient groups gained weight, body mass index (BMI), and fat-free mass (FFM) (P < 0.05 versus baseline), whereas only AIDS patients gained fat mass. Increases were more pronounced in the AIDS group. REE was elevated compared with corresponding controls at baseline, and decreased similarly in HIV and in AIDS patients during PI therapy (P < 0.05). The reduction in the viral burden preceded the decrease in REE by several weeks.


CONCLUSIONS
Body composition and metabolic parameters improved during PI therapy in HIV-infected and AIDS patients without wasting. Although an early reduction in viral load as a result of HAART does not seem to influence REE directly, sustained viral load suppression may promote a decrease in energy expenditure.
Pernerstorfer-Schoen
H
H
Department of Dermatology, University of Vienna Medical School, Vienna General Hospital, Austria. heidemarie.pernerstorfer-schoen@univie.ac.at
Schindler
K
K
Parschalk
B
B
Schindl
A
A
Thoeny-Lampert
S
S
Wunderer
K
K
Elmadfa
I
I
Tschachler
E
E
Jilma
B
B
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D001481:Basal Metabolism / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects; D016022:Case-Control Studies; D015331:Cohort Studies; D016049:Didanosine / Q000627:therapeutic use; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000627:therapeutic use; D011446:Prospective Studies; D018119:Stavudine / Q000627:therapeutic use; D014766:Viremia / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology
D017320:HIV Protease Inhibitors; D018119:Stavudine; D019888:Nelfinavir; D016049:Didanosine