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Biological Relationship Between HIV and Nutrition Christine Wanke , MD. Malnutrition in HIV. Intestinal injury. Malabsorption. Increased risk for enteric pathogens. Diarrhea. Further Immune Dysfunction. Malnutrition. Weight loss pre-ART.

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Biological Relationship Between HIV and NutritionChristine Wanke, MD


Malnutrition in hiv
Malnutrition in HIV

Intestinal injury

Malabsorption

Increased risk for enteric

pathogens

Diarrhea

Further Immune Dysfunction

Malnutrition


Weight loss pre art
Weight loss pre-ART

  • Death associated with weight less than 66% of ideal body weight

  • Death associated with lean body mass falling below 54%

  • Independent risk factor for death in HIV

  • Weight loss also associated with increased risk for hospitalization, decreased quality of life

  • Increased progression of HIV

  • As little as 5% weight loss was associated with mortality and increased risk of opportunistic infection

    ..

Chlebowski RT, 1989; 6. Guenter P, 1993; Palenicek JP, 1995;.Cohan GR, 1992. Turner J, 1994.Wheeler DA, 1996, Wilson


Bmi and survival in hiv in south india n 3262
BMI and Survival in HIV in South India, n=3262

Saghayam, unpublished 2008



Nutritional status at initiation of art association with mortality
Nutritional status at initiation of ART: association with mortality

Paton 2006, Stringer 2006, Zaccharia 2006, Johannsesen 2008


Weight loss and survival in era of art
Weight Loss and Survival in Era of ART: mortality

Adapted from Tang AM, et al. JAIDS. 2002;31:230-236.


Etiology of weight loss in hiv
Etiology of Weight Loss in HIV mortality:

  • Inadequate Caloric Intake

    • Symptoms

    • Access to food/ food security

    • Malabsorption/ diarrhea

  • Altered Metabolism

    • HIV

    • Opportunistic Infections


Frequency of symptoms that may contribute to nutritional compromise in hiv infection in south india
Frequency of Symptoms that may Contribute to Nutritional Compromise in HIV Infection in South India

Saghayam, unpublished


Prevalence of intestinal dysfunction in hiv in south india
Prevalence of Intestinal Dysfunction in HIV in South India Compromise in HIV Infection in South India

R. Isaac, unpublished


Change in body weight and bmi by categories of change in viral load untreated hiv
Change in body weight and BMI by categories of change in viral load: untreated HIV

Weight

(p<0.001)

BMI

(p<0.001)

Mwamburi et al 2004


Nutritional Status in HIV Positive (Advanced and Early Disease) and HIV Negative Individuals in South India

Saghayam unpublished


Does 6 months of art improve nutritional status in hiv in india
Does 6 months of ART Improve Nutritional Status in HIV in India?

  • 190 HIV-infected patients initiating HAART in Chennai, South India at YRG CARE

  • Mean age 35 years (range 20-62 years)

  • 85% male

  • Overall body weight increased mean 2.8 kg (range –12.5-22.5 kg)

    • 41 (22%) lost weight (>1 kg)

    • 37 (19%) were weight stable (change < 1 kg)

    • 112 (59%) gained weight (> 1 kg)

Saghayam, unpublished


Impact of Treatment of HIV: India?

Anthropometric Parameters after 6 months on HAART in South India



Summary
Summary in South India

  • Weight loss in HIV is associated with morbidity and mortality

    • Whether or not on ART

  • Weight loss is likely multifactorial

  • Response needs to consider etiology

    • Treatment of HIV

    • Treatment of OIs (TB)

    • Control of symptoms


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