BODY-COMPOSITION CHANGES IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Malnutrition characterized by weight loss and often extreme wasting ge nerally develops when patients progress from infection with human immu nodeficiency virus (HIV) to AIDS. There is evidence that before the de velopment of AIDS, HIV-infected patients without weight loss show earl y signs of malnutrition, defined as an increase in the ratio of extrac ellular mass (ECM) to body cell mass (BCM). As part of a dietary inter vention study, body composition measurements were obtained at baseline and after 6 wk in 18 patients with HIV infection and CD4 counts betwe en 140 and 740 cells/mm(3). Only one patient had a prior weight loss ( 3.7 kg); patients gained 2 pounds after 3 wk of dietary supplementatio n of 500 kcal daily. Bioelectrical impedance was used to measure body compartments. The average ECM/BCM ratio (0.77 +/- 0.13) was within the normal range (0.83 +/- 0.16) indicating the absence of malnutrition b y this criterion. Most measurements of BCM (kg) approximated normal va lues, while several for ECM (kg) exceeded normal. BCM (kg) correlated poorly with the ECM/BCM ratio (r(2) = 0.08; P = 0.11) in contrast to E CM (kg), which was well correlated (r(2) = 0.82; P = 0.00). In additio n, there was a significant correlation of body mass index (BMI) with t he ECM/BCM ratio (r(2) = 0.38; P - 0.00) and with ECM (r(2) = 0.244; P = 0.003) indicating that overweight patients may be more likely to be considered malnourished than normal weight patients using this ratio. Without use of bioelectrical impedance, these subtle changes might be missed. Once significant weight loss has occurred coupled with decrea ses in BCM (kg), the ECM/BCM ratio may be more reflective of malnutrit ion. These conjectures will require prospective evaluation, but for no w it seems reasonable to include bioelectrical impedance as a potentia lly useful tool in the evaluation of malnutrition in this population. (C) Elsevier Science Inc. 1997.