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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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Presentation Transcript
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

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:

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

etiology of weight loss in hiv
Etiology of Weight Loss in HIV:
  • 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Saghayam, unpublished

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

slide12

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Saghayam unpublished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

slide14

Impact of Treatment of HIV:

Anthropometric Parameters after 6 months on HAART in South India

summary
Summary
  • 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