Metabolic abnormalities and wasting in human immunodeficiency virus infection

Macallan, Derek C.

doi:10.1079/pns19980054

Cited by 14 publications

(12 citation statements)

References 32 publications

(23 reference statements)

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“…Patientreported symptoms have been shown elsewhere to be important independent predictors of weight loss [11,12]. Symptoms may impose barriers to food intake [29], be indicators of nutrient malabsorption [30], or be indicators of illnesses that change metabolic needs and decrease physical activity [29,31]. Macallan and colleagues [29,31] argue that the primary factor driving acute weight loss is reduced intake or anorexia mediated by HIV and secondary infections.…”

Section: Discussionmentioning

confidence: 97%

“…Symptoms may impose barriers to food intake [29], be indicators of nutrient malabsorption [30], or be indicators of illnesses that change metabolic needs and decrease physical activity [29,31]. Macallan and colleagues [29,31] argue that the primary factor driving acute weight loss is reduced intake or anorexia mediated by HIV and secondary infections. In our study, symptoms that might interfere with food intake (oral symptom complex and trouble swallowing) were predictive of acute weight loss, but anorexia was not.…”

Section: Discussionmentioning

confidence: 98%

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Difficulty Swallowing and Lack of Receipt of Highly Active Antiretroviral Therapy Predict Acute Weight Loss in Human Immunodeficiency Virus Disease

Jacobson

Bica

Knox

et al. 2003

Clinical Infectious Diseases

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In human immunodeficiency virus (HIV) disease, symptoms of underlying illness may promote weight loss through decreased caloric intake, increased metabolic needs, or nutrient malabsorption. We evaluated disease symptoms as predictors of acute weight loss (i.e., loss of > or =5% of weight). HIV-infected men and women (n=415) were telephoned every 5 weeks to obtain information about weight and recent symptoms. Weight change between each pair of consecutive calls (telephone intervals, 2814) was calculated. Acute weight loss occurred across 4.5% of intervals and among 24% of individuals. Patients reported > or =1 symptom before 58% of telephone intervals. The most common symptoms or symptom complexes before intervals were diarrhea (21% of patients), anorexia (17%), upper respiratory symptoms (16%), skin symptoms (12%), and abdominal pain (12%). Trouble swallowing (6%) and oral symptoms (7%) were less common. Risk of acute weight loss was significantly increased when oral symptoms or trouble swallowing were present, and it was decreased when highly active antiretroviral therapy (HAART) was used or when diarrhea was not present. Even when HAART is being administered, clinicians should remain vigilant regarding weight loss, oral symptoms, and trouble swallowing.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Difficulty Swallowing and Lack of Receipt of Highly Active Antiretroviral Therapy Predict Acute Weight Loss in Human Immunodeficiency Virus Disease

Jacobson

Bica

Knox

et al. 2003

Clinical Infectious Diseases

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“…All areas of intermediary metabolism appear to be affected, including energy balance, carbohydrate metabolism, protein metabolism and lipid metabolism, although the relative contributions of each remains unclear (Macallan, 1998). A full discussion is not possible here, but abnormalities such as accelerated wholebody protein turnover, altered carbohydrate metabolism and hyperlipidaemia are characteristic of infection (Hommes et al 1991a,b;Grunfeld et al 1992;Hellerstein et al 1993;Macallan et al 1995a).…”

Section: Wasting In Human Immunodeficiency Virus Infectionmentioning

confidence: 99%

Nutrition and immune function in human immunodeficiency virus infection

Macallan

1999

Proc. Nutr. Soc.

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The triad of human immunodeficiency virus (HIV) infection, nutritional status and immune function are intimately related, each factor having effects on the others. The dominant effect in this three-way relationship is the effect of HIV infection on nutritional status, an effect which, until the advent of potent anti-retroviral drugs, has been manifest primarily as wasting. Recently, more complex metabolic abnormalities have become apparent, particularly fat redistribution syndromes, hyperlipidaemia and hypercholesterolaemia. For the converse effect, the effect of nutritional state on HIV disease progression, there is good evidence that clinical outcome is poorer in individuals with compromised nutrition. However, the beneficial effects of nutritional support have been more difficult to demonstrate. For macronutrients, effective macronutrient supply improves survival in severely-malnourished individuals and may have beneficial effects in less-severely-affected individuals. Micronutrient deficiencies appear to be involved in modifying clinical HIV disease and may also be associated with enhanced mother-to-child transmission of virus, particularly in developing countries. Intervention trials in this setting are currently under way. In conclusion, the interaction of HIV infection and nutrition is of great importance not just because of the major impact that HIV infection has on nutritional state, but also because strategies to improve nutritional status, both quantitatively and qualitatively, may have a beneficial effect on the clinical and immunological course of the disease.

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“…Asymptomatic HIV-infected individuals had a 16 % greater resting energy expenditure than uninfected individuals, while HIV-infected subjects who also had other opportunistic infections had a 57 % greater resting energy expenditure than controls. The increased energy expenditure often occurs in combination with anorexia and malabsorption, resulting in body wasting (for review see Macallan, 1998). Macallan et al (1995) showed that the weight loss among British adults with HIV infection was largely a consequence of reduced energy intake, rather than increased energy expenditure.…”

Section: Infections Can Cause Malnutritionmentioning

confidence: 99%

Undernutrition, infection and immune function

2000

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Undernutrition and infection are the major causes of morbidity and mortality in the developing world. These two problems are interrelated. Undernutrition compromises barrier function, allowing easier access by pathogens, and compromises immune function, decreasing the ability of the host to eliminate pathogens once they enter the body. Thus, malnutrition predisposes to infections. Infections can alter nutritional status mediated by changes in dietary intake, absorption and nutrient requirements and losses of endogenous nutrients.

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Metabolic abnormalities and wasting in human immunodeficiency virus infection

Cited by 14 publications

References 32 publications

Difficulty Swallowing and Lack of Receipt of Highly Active Antiretroviral Therapy Predict Acute Weight Loss in Human Immunodeficiency Virus Disease

Difficulty Swallowing and Lack of Receipt of Highly Active Antiretroviral Therapy Predict Acute Weight Loss in Human Immunodeficiency Virus Disease

Nutrition and immune function in human immunodeficiency virus infection

Undernutrition, infection and immune function

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