Nutritional alterations associated with HIV infection

Nutritional alterations are common in HIV infection. Early studies document ed weight loss and protein depletion, a finding associated with body cell m ass depletion in untreated patients. The application of highly active antir etroviral therapy has led to a decreased incidence of malnutrition, althoug h altered body fat distribution and metabolic alterations, including hyperl ipidemia and insulin resistance, are common sequelae. The development of ma lnutrition is multifactorial and occurs through changes in caloric intake, nutrient absorption, or energy expenditure. Clinically, malnutrition develo ps as a result of either starvation or cachexia. Other hormonal and endocri nologic alterations include hypercortisolemia and hypogonadism. The rationa le for providing nutritional support to AIDS patients is based upon the ass umptions that nutrition status can be improved and that such improvements h ave clinical benefits. The results or hypercaloric feeding studies, includi ng the use of appetite stimulants, indicate that weight gain is possible bu t that the weight gained is predominantly fat. In contrast, anabolic agents and resistance training exercise have been shown to promote body cell mass repletion and skeletal muscle gain. Cytokine inhibitors also have been eva luated for the treatment of wasting in HIV infection. Development of combin ation therapies, preventive therapies, and efficient and cost-effective the rapies are current tasks in the field.