Clinical Assessment of Nutritional and Metabolic Status in HIV Outpatients

Abstract

Background: After the World Health Organization’s first technical consultation on Nutrient Requirements for People Living with HIV/AIDS in Geneva, 2003, a lot of research questions that are considered crucial for enhancing our understanding of the interaction of nutrition and HIV infection were raised and until this moment, left unanswered. To gain a better understanding of HIV and nutrition, we implemented a comprehensive approach. The aim of our study was to assess the nutritional and metabolic status in order to enhance the provision of medical care to people living with HIV. Methods: 45 HIV patients and 32 healthy volunteers were enrolled in the study. Within the HIV group, 32 (71%) were male and 13 (29%) female. Only 7 (15%) were ART naïve. Overall their median age, CD4 count and viral load were 30 years (IQR: 28-40), 407 (IQR: 357-490) cells/mm3 and 500 (IQR: 0-1000) copies/ml, respectively. None of the participants in the HIV group had any active infection. Food intake by monthly dietary recall was determined. Body composition was measured using bioelectrical impedance analysis. The selected biochemical parameters were evaluated and the resting metabolic rates were calculated using indirect calorimetry to accurately understand the metabolism of participants. Results: Participants in the HIV group did not meet the recommended daily allowance level (RDA) of carbohydrate requirements. The fat-free mass significantly decreased in the HIV group (P < 0.05). Resting energy expenditure was excessive in the HIV group compared to the control group (P < 0.05). Values of urea nitrogen concentration, fat and protein oxidation rates in the HIV group significantly increased (P < 0.01). The carbohydrate oxidation in the HIV group significantly decreased (P < 0.01) Conclusions: The study reveals a catabolic status in the HIV group and suggests an adjustment in the nutrient RDA to compensate such status. Further investigation should be extended to vulnerable population group particularly children.