EFFECT OF PARENTERAL MEDIUM-CHAIN AND LONG-CHAIN TRIGLYCERIDES ON LYMPHOCYTES SUBPOPULATIONS AND FUNCTIONS IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME - A PROSPECTIVE-STUDY

Background: Total parenteral nutrition (TPN) may offer significant cli nical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients. Methods: W e undertook a prospective randomized double-blind multicenter study co mparing the effects of two IV lipid emulsions used during TPN: long-ch ain triglycerides (LCT) or balanced emulsion of long-and medium-chain triglycerides (LCT/MCT). Thirty-three AIDS patients requiring TPN for wasting and reduced oral intake were allocated randomly to receive a t ernary TPN mixture consisting of 1.5 g/kg/d proteins, 18 kcal/kg/d lip ids, and 12 kcal/g/d carbohydrates for 6 days. The following tests wer e pet-formed at days 0 and 7: inununoglobulins, complement fractions, lymphocyte subpopulations count, and lymphocyte proliferation with mit ogens. Results: Patients were all severely malnourished (weight loss: -14.0 +/- 1.3 kg). No clinical or biological differences were observed between the groups at baseline. At day 7, both groups reported a sign ificant increase in weight. Patients in the LCT group exhibited a sign ificant decrease in phytohemagglutinin A response (p = .04) compared w ith baseline. Patients in the LCT/MCT group exhibited a lower level of IgM (P = .03) and a significant increase in C3 fraction (P = .03) com pared with baseline. They also showed a tendency to have a higher CD4/ CD8 lymphocyte ratio (p = .01), whereas other immunological parameters remained unchanged. Conclusions: Parenteral ternary mixture containin g LCT or LCT/MCT are clinically well tolerated in AIDS patients over 6 days. With 2 g/kg/d of lipids, LCT seems to induce significant abnorm alities in lymphocyte function. Such abnormalities are not observed wi th LCT/MCT.