Identificador: TDX:611
Autores: Jimenez Expósito, Maria Jesús
Resumen:
OBJETIVES: 1) To determine nutritional status, metabolic status, incidence and severity of malabsorption at different stages of HIV infection, and compared with a control group; 2) To asses the influence of malabsorption on nutritional status and resting energy expenditure (REE) in these patients, as well as, the contribution to weight loss of REE and malabsoprtion.METHODS: Fifty HIV patients were classified into three groups: Group 1 (n = 17), HIV-positive asymptomatic; Group 2 (n = 16), AIDS without opportunistic infection; Group 3 (n = 17), AIDS with active infection. Clinically-healthy subjects (n = 19) were used as controls. Parameters measured were: Anthropometry; Body composition (tetrapolar bioelectrical impedance); REE (open-circuit indirect calorimetry); Malabsorption (triolein breath and D-xylose absorption tests); Serum concentrations of vitamina A, E, copper and zinc, and inflammatory parameters.RESULTS: A total of 86% (n = 43) of the HIV-patients had weight loss, in general of slight-moderate range. The incidence and severity of weight loss was higher in presence of opportunistic infection, although a total of 76% HIV-positive asymptomatic subjects had weight loss. Fat-free-mass (FFM) was significantly lower, and the fat mass was lower (p < 0.05 Group 1; NS Group 2; p < 0.001 Group 3) in the three patients group than in controls.Serum vitamin A and E levels were below the reference range in 28% and 12% patients respectively, but not in controls subjects. The prevalence of vitamin A deficiency increased with the severity of the disease. Fewer patients than controls had values below the reference range regarding serum copper (10% versus 21%; NS), but not regarding serum cinc (34% versus 11%; p < 0.05). Serum concentrations of vitamin A were significantly correlated with reactive protein C (r = -0.31; p < 0.05).The values of REE measured by indirect calorimetry were lower in the three patient groups compared with the control group, with a statistically significant difference between AIDS patients with active infection and controls (5861.6  932.1 versus 6802.1  862.7 kJ/d; p < 0.01). The values of REE adjusted for FFM were slightly higher in the three patients group than in the control group but the differences were not statistically significant. Both the measured REE and the adjusted were lower, although not significantly so, in the Group 3 patients compared with the other groups of patients. Malabsorption (defined as abnormality of xylose and/or fat absorption test) was found in 34 (68%) of patients: 9 (53%) Group 1; 11 (69%) Group 2; 14 (82%) Group 3. REE measured was significantly lower in malabsorptive patients than in non-malabsorptive patients and controls (6006.3  846.5 versus 6443.4  985.5 versus 6802.1  862.7 kJ/d, respectively; p < 0.05). REE adjusted was lower in malabsorptive than in non-malabsorptive patients and slightly higher than in controls, although the differences were not statistically significant. A significant relationship was observed between malabsorption parameters and weight loss.CONCLUSIONS: HIV-infected patients show a alteration of nutritional status, more severe in advanced stages, and especially in presence of opportunistic infection. Micronutrient deficiencies are prevalent in HV-infected patients, including asymptomatic patients. Some micronutrients were significantly correlated with inflammatory parameters, suggesting that their serum concentrations have more to do with the inflammatory response than with the nutritional status. Malabsorption is a frequent feature in HIV-infection and is related to the HIV-related weight loss. The presence of malabsorption results in a more severe alteration of the nutritional status and decrease of the REE, and so could explain the lower grade of hypermetabolism observed, especially in patients with opportunistic infections. Hypermetabolism is not a constant phenomenon in HIV infection since, in the presence of malabsorption, our patients show an appropiate metabolic response.
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