Wasting and Lipodystrophy in Patients Infected With HIV
This article is based on a presentation given by the author at the amfAR-sponsored conference "Use of Steroids and Human Growth Hormone in HIV/AIDS," held June 12, 2000, in Dallas. The care of patients who have HIV infection must address multiple medical, psychological, and socioeconomic factors. Because of the time constraints of a typical 15-minute office visit, important issues may be overlooked unless the physician has a clear concept of priorities and a clear method of tracking information. Although the medical aspects -- viral control -- must take priority, the psychological and social consequences of the illness must not be ignored. Nutritional evaluation and counseling must be addressed because nutritional disturbances often adversely affect the general health of patients who are infected with HIV. Important nutritional complications of HIV infection are the syndromes of wasting and lipodystrophy. However, the onset of wasting may not be heralded by a change in the patient's weight. In patients who have AIDS, the mechanism leading to a loss of skeletal muscle mass has not been identified. HIV-related lipodystrophy consists of accumulation of fat in the subcutaneous tissues of the lower trunk, abdominal viscera, and dorsocervical region with loss of fat from the upper and lower extremities, buttocks, and face. Lipodystrophy in association with HIV infection is not the same as the wasting syndrome of protein-energy malnutrition. An early sign of lipodystrophy is facial wasting. The treatment of the nutritional complications of HIV infection includes exercise; nutritional counseling; and in selected patients, androgenic hormones, anabolic steroid hormones, and human growth hormone.
In any clinical practice that provides care for HIV-infected patients, the daily problems that must be faced include those related to antiretroviral therapies, nutrition, psychosocial issues, and prevention of opportunistic infections. At times, it is easier to deal with the first and last of these problems because there are well-accepted guidelines for managing them. On the other hand, insurance carriers usually have definitions of nutritional disturbances that do not match those that are the reality for HIV-infected patients, and dealing with nutritional issues by providing nutritional education is usually not reimbursable. There is also only so much a physician can do for a patient during a short visit when the number of patients needing care is so overwhelming.
However, if the nutritional aspects of the patient's HIV care are neglected, and lipodystrophy, wasting, or another metabolic derangement develops, the patient's health will be adversely affected. We know that weight loss in an HIV-infected patient increases the risk of hospitalization. Depletion of body cell mass (BCM) increases the likelihood of opportunistic infections; it is also an independent risk factor for increased morbidity and mortality, not only in HIV-infected patients but in many other patients as well.
The 2 most important nutritional/metabolic problems in HIV-infected patients are wasting and lipodystrophy. HIV-related wasting has been recognized almost since the start of the epidemic, but lipodystrophy is a relatively new phenomenon.
This article is based on a presentation given by the author at the amfAR-sponsored conference "Use of Steroids and Human Growth Hormone in HIV/AIDS," held June 12, 2000, in Dallas. The care of patients who have HIV infection must address multiple medical, psychological, and socioeconomic factors. Because of the time constraints of a typical 15-minute office visit, important issues may be overlooked unless the physician has a clear concept of priorities and a clear method of tracking information. Although the medical aspects -- viral control -- must take priority, the psychological and social consequences of the illness must not be ignored. Nutritional evaluation and counseling must be addressed because nutritional disturbances often adversely affect the general health of patients who are infected with HIV. Important nutritional complications of HIV infection are the syndromes of wasting and lipodystrophy. However, the onset of wasting may not be heralded by a change in the patient's weight. In patients who have AIDS, the mechanism leading to a loss of skeletal muscle mass has not been identified. HIV-related lipodystrophy consists of accumulation of fat in the subcutaneous tissues of the lower trunk, abdominal viscera, and dorsocervical region with loss of fat from the upper and lower extremities, buttocks, and face. Lipodystrophy in association with HIV infection is not the same as the wasting syndrome of protein-energy malnutrition. An early sign of lipodystrophy is facial wasting. The treatment of the nutritional complications of HIV infection includes exercise; nutritional counseling; and in selected patients, androgenic hormones, anabolic steroid hormones, and human growth hormone.
In any clinical practice that provides care for HIV-infected patients, the daily problems that must be faced include those related to antiretroviral therapies, nutrition, psychosocial issues, and prevention of opportunistic infections. At times, it is easier to deal with the first and last of these problems because there are well-accepted guidelines for managing them. On the other hand, insurance carriers usually have definitions of nutritional disturbances that do not match those that are the reality for HIV-infected patients, and dealing with nutritional issues by providing nutritional education is usually not reimbursable. There is also only so much a physician can do for a patient during a short visit when the number of patients needing care is so overwhelming.
However, if the nutritional aspects of the patient's HIV care are neglected, and lipodystrophy, wasting, or another metabolic derangement develops, the patient's health will be adversely affected. We know that weight loss in an HIV-infected patient increases the risk of hospitalization. Depletion of body cell mass (BCM) increases the likelihood of opportunistic infections; it is also an independent risk factor for increased morbidity and mortality, not only in HIV-infected patients but in many other patients as well.
The 2 most important nutritional/metabolic problems in HIV-infected patients are wasting and lipodystrophy. HIV-related wasting has been recognized almost since the start of the epidemic, but lipodystrophy is a relatively new phenomenon.
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