THE METABOLIC RESPONSE TO OPPORTUNISTIC INFECTIONS IN AIDS

Objective: The metabolic response to AIDS-defining opportunistic infec tions was examined to provide a logical basis for the management of as sociated weight loss. Design: A prospective study of metabolism in AID S. Setting: HIV outpatients' department and wards at the Chelsea and W estminster Hospital, London. Patients: Ten asymptomatic Centers for Di sease Control and Prevention stage II HIV-seropositive control subject s and 36 HIV-seropositive patients with a single newly diagnosed and u ntreated opportunistic infection [10 with microsporidial or cryptospor idial diarrhoea, 10 with Pneumocystis carinii pneumonia, nine with cyt omegalovirus enteritis and seven with systemic Mycobacterium avium-int racellulare]. Main outcome measurements: Subjects had measurements of resting energy expenditure using indirect calorimetry and of body comp osition using dual energy X-ray absorptiometry. Results: Subjects with protozoal diarrhoea had a decreased resting energy expenditure (P < 0 .05) and decreased body fat (P < 0.01). Subjects with P. carinii pneum onia had an elevated resting energy expenditure (P< 0.05). Subjects wi th systemic M. avium-intracellulare had an elevated resting energy exp enditure (P < 0.05) and decreased skeletal muscle mass (P < 0.05). Sub jects with cytomegalovirus enteritis had a non-significant elevation o f resting energy expenditure with a non-significant toss of both fat a nd lean tissue. Conclusion: Subjects with protozoal diarrhoea show a s tarvation response to infection and subjects with systemic M. avium-in tracellulare show a cachectic response. Since there is a variation in the metabolic response to opportunistic infection in AIDS patients, nu tritional management should be directed according to the specific caus e.