SHORT-TERM EFFECTS OF LIPID-BASED PARENTERAL-NUTRITION IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME AND PNEUMOCYSTIS-CARINII PNEUMONIA

The human immunodeficiency virus (HIV) is surrounded by a rigid membra ne rich in cholesterol. Extraction of cholesterol from the virus envel ope reduces its infectivity in vitro. Large amounts of lipid emulsion phospholipids have the property of extracting cholesterol from cell me mbranes. The purpose of the present study was to observe the effects o f high phospholipid loads on the lipid profile as well as HIV infectiv ity of patients with acquired immunodeficiency syndrome (AIDS). Fifty- nine patients with AIDS, weight loss, and presenting Pneumocystis cari nii pneumonia (PCP) were included in a prospective, randomised, contro lled study. In addition to standard therapy, patients received for 2 w eeks 910 kcal of peripheral parenteral nutrition including 20% lipid e mulsion (group 1) or a new 2% lipid emulsion with a high phospholipid/ triglyceride ratio (1:1.7) (group 2). Activity level and biological, i mmune and HIV load and infectivity parameters were followed. Cholester ol increased from 113 +/- 44 to 228 +/- 103 mg/dl in the 2% group (P < 0.00001). Triglycerides also increased significantly (P < 0.02). IgA was decreased in the 2% group. HIV load and infectivity tests and leuk ocyte subsets did not demonstrate any effect of the lipid emulsions. I t is concluded that the new 2% emulsion is a powerful cholesterol extr actor. However, 2 weeks' administration failed to show any efficacy in modifying immune parameters or HIV infectivity in AIDS patients with PCP.