Hostname: page-component-84b7d79bbc-x5cpj Total loading time: 0 Render date: 2024-07-25T14:13:59.743Z Has data issue: false hasContentIssue false
  • English
  • Français

Nutrition support and the human immunodeficiency virus (HIV)

Published online by Cambridge University Press:  06 April 2009

S. J. Bell ,
E. A. Mascioli ,
R. A. Forse  and
B. R. Bistrian
S. J. Bell*
Affiliation:
Surgical Metabolism Laboratory, 194 Pilgrim Road, Deaconess Hospital, Boston, MA 02215, USA
E. A. Mascioli
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
R. A. Forse
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
B. R. Bistrian
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
*
*Corresponding author.
Get access Rights & Permissions [Opens in a new window]

Summary

Nutritional support of patients with HIV or acquired immune deficiency syndrome (AIDS) has many similarities to other disease states in that the same nutritional products and techniques are used. Some patients with HIV, and many with AIDS without secondary infection, experience a metabolic milieu similar to patients with cancer cachexia. In providing dietary counselling to the HIV patient, we encounter many of the obstacles that must be overcome to improve nutrition in cancer: anorexia, gastrointestinal discomfort, lethargy, and poor nutrient utilization, which limit the ability for nutritional repletion. When a secondary infection is superimposed on HIV, patients resemble more highly catabolic trauma patients or patients in the intensive care unit (ICU), where, despite aggressive efforts to feed, there is usually a net nitrogen wasting leading to the more rapid development of cachexia. However, even in this setting, feeding will limit substantially net catabolism when compared to total starvation. Because the nutritional needs of HIV patients vary greatly, individual strategies have to be designed as the patient moves through the stages of disease. Patients are generally able to consume adequate nutrition either as regular food or dietary supplements during the latency period of viral replication. Once secondary infections become prevalent, artificial diets administered by tube or by vein may be required during the period of active secondary infections, with dietary supplements often helpful during more quiescent periods. Patients with HIV are among the most challenging for clinicians providing nutritional support. Knowledge from treatment of patients with other diseases may be useful, but more data must be gathered on the unique aspects of aetiology and treatment of the anorexia, malabsorption, and ultimate wasting associated with AIDS.

Keywords

nutrition supportAIDSmalnutrituion
Type
Research Article
Information
Parasitology , Volume 107 , supplement S1: Human nutrition and parasitic infection , January 1993 , pp. S53 - S67
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Society For Parenteral and Enteral nutrition board of directors (1986). Guidelines for use of total parenteral nutrition in the hospitalized patient. Journal of Parenteral and Enteral Nutrition 10, 441–4.CrossRefGoogle Scholar
Anderson, R. M. & Ray, R. A. (1992). Understanding the AIDS pandemic. Scientific American 390, 58–66.CrossRefGoogle Scholar
Beutler, B. A. & Cerami, A. (1985). Recombinant interleukin 1 suppresses lipoprotein lipase activity in 3T3-LI cells. Journal of Immunology 135, 3969–71.CrossRefGoogle Scholar
Bistrian, B. R., Blackburn, G. L., Hallowell, E. & Heddle, R. (1974). Protein status of general surgical patients. Journal of the American Medical Association 230, 858–60.CrossRefGoogle ScholarPubMed
Bistrian, B. R., Blackburn, G. L., Vitale, J., Cochran, D. & Naylor, J. (1976). Prevalence of malnutrition in general medical patients. Journal of the American Medical Association 235, 1557–70.Google ScholarPubMed
Blattner, W. A. (1991). HIV epidemiology: past, present, and future. Federation of the American Society of Experimental Biology Journal 5, 2340–8.Google Scholar
Bogden, J. D., Baker, H., Frank, O., Perez, G., Kemp, F., Bruening, K. & Louria, D. (1990). Micronutrient status and human immunodeficiency virus (HIV) infection. Annals of the New York Academy of Sciences 587, 189–95.CrossRefGoogle ScholarPubMed
Brolin, R. E., Gorman, R. C., Milgrim, L. M., Abbott, J. M. & George, S. (1991). Use of nutrition support in patients with AIDS, (abstract) In Proceedings of the American Society of Parenteral and Enteral Nutrition, Fourteenth Clinical Congress, 01 28–31, San Antonio, Texas, P. 436.Google Scholar
Chlebowski, R. T., Grosvenor, M. B., Bernhard, N. H., Morales, L. S. & Bulcavage, L. M. (1989). Nutritional status, gastrointestinal dysfunction, and survival in patients with AIDS. American Journal of Gastroenterology 84, 1288–93.Google ScholarPubMed
Desrosiers, R. C. (1992). HIV with multiple gene deletions as a live attenuated vaccine for AIDS. AIDS Research Human Retrovirus 8, 411–21.CrossRefGoogle ScholarPubMed
Dworkin, B. M., Rosenthal, W. S., Wormser, G. P. & Weiss, L. (1986). Selenium deficiency in the acquired immunodeficiency syndrome. Journal of Parenteral and Enteral Nutrition 10, 405–7.Google Scholar
Dworkin, B. M., Wormser, G. P., Axelrod, F., Pierre, N., Schwarz, E., Schwartz, E. & Seaton, T. (1990). Dietary intake in patients with acquired immunodeficiency syndrome (AIDS), patients with AIDS-related complex, and serologically positive human immunodeficiency virus patients: correlations with nutritional status. Journal of Parenteral and Enteral Nutrition 14, 605–9.Google Scholar
Dwyer, J. T. (1991). Nutrition support of HIV + patients. Henry Ford Hospital Medical Journal 39, 60–5.Google ScholarPubMed
Dwyer, J. T., Bye, R. L., Holt, P. L. & Lauze, S. R. (1988). Unproven nutrition therapies for AIDS: what is the evidence? Nutrition Today Mar/Apr, 25–33.CrossRefGoogle Scholar
Feingold, K. R., Serio, M. K., Adi, S., Moser, A. H. & Grunfeld, C. (1989 a). Tumor necrosis factor stimulated hepatic lipid synthesis and secretion. Endocrinology 124, 2336–42.CrossRefGoogle ScholarPubMed
Feingold, K. R., Soued, M., Serio, M. K., Moser, A. H., Dinarello, C. A. & Grunfeld, C. (1989 b). Multiple cytokines stimulate hepatic lipid synthesis in vivo. Endocrinology 125, 267–74.CrossRefGoogle ScholarPubMed
Fong, Y. & Lowry, S. F. (1990). Cytokines and the cellular response to injury and infection. Scientific American IV Trauma, Chapter 7, 1–17.Google Scholar
Galvin, T. A. (1992). Micronutrients: implications in human immunodeficiency virus disease. Topics in Clinical Nutrition 7, 63–73.Google Scholar
Ghiron, L., Dwyer, J. & Stollman, L. B. (1989). Nutritional therapy for AIDS: new directions. Clinical Nutrition 8, 114–19.Google Scholar
Grunfeld, C. & Feingold, K. R. (1992). Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. New England Journal of Medicine 327, 329–37.Google ScholarPubMed
Grunfeld, C., Wilking, H., Neese, R., Gavin, L. A., Moser, A. H., Gulli, R., Serio, M. K. & Feingold, K. R. (1989). Persistance of the hypertriglyceridemic effect of tumor necrosis factor despite development of tachyphylaxis to its anorectic/cachetic effects in rats. Cancer Research 49, 2554–60.Google Scholar
Grunfeld, C., Kotler, D. P., Shigenaga, J. K., Doerrler, W., Tierney, A., Wang, J., Pierson, R. N. & Feingold, K. R. (1991). Circulating interferon-α levels and hypertriglyceridemia in the acquired immunodeficiency syndrome. American Journal of Medicine 90, 154–62.Google Scholar
Grunfeld, C., Pang, M., Shimizu, L., Shigenaga, J. K., Jensen, P. & Feingold, K. R. (1992). Resting energy expenditure, caloric intake, and short-term weight change in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. American Journal of Clinical Nutrition 55, 455–60.CrossRefGoogle ScholarPubMed
Guenter, P. A., Muurahainen, N., Cohan, C. R. & Turner, J. L. (1992). Relationship between nutritional status CD4 counts and survival in HIV infection. American Society of Clinical Nutrition 04 30, abstract, Baltimore, MD.Google Scholar
Hellerstein, M. K., Kahn, J., Mudie, H. & Viteri, F. (1990). Current approach to the treatment of human immunodeficiency virus-associated weight loss: pathophysiologic consideration and emerging management strategies. Seminars in Oncology 17, 17–33.Google Scholar
Henry, K. (1988). Alternative therapies for AIDS. Minnesota Medicine 71, 7–299.Google Scholar
Hirschberg, V., Pomposelli, J. J., Blackburn, G. L., Istfan, N. W., Babayan, V. K. & Bistrian, B. R. (1990). The effect of chronic fish oil feeding in rats on protein catabolism induced by recombinant mediators. Metabolism 39, 397–02.Google Scholar
Hommes, M. J. T., Romijin, J. A., Endert, E. & Sauerwein, H. P. (1991 a).Resting energy expenditure and substrate oxidation in human immunodeficiency virus (HlV-l)-infected asymptomatic men: HIV affects host metabolism in the early asymptomatic stage. American Journal of Clinical Nutrition 54, 311–15.Google Scholar
Hommes, M. J. T., Romijin, J. A., Endert, E., Schattenkerk, J. K. M. & Sauerwein, H. P. (1991 b). Basal fuel homeostasis in symptomatic human immunodeficiency virus infection. Clinical Science 80, 359–65.Google Scholar
Jacobs, D. O., Black, P. R. & Wilmore, D. W. (1990). Hormone-substrate interactions. In Enteral and Tube Feeding, 2 edn (ed. Rombeau, J. L. & Caldwell, M. D.), pp. 34–53. Philadelphia: W. B. Saunders.Google Scholar
Janson, D. D. & Teasley, K. M. (1988). Parenteral nutrition in the management of gastrointestinal Kaposi's sarcoma in a patient with AIDS. American Society of Hospital Pharmacists 7, 536–44.Google Scholar
King, D. (1992). Bold global AIDS strategy urged. Boston Globe, 8 June. (Merser and Mann 1992).Google Scholar
Kotler, D. P. (1991). Biological and clinical features of HIV infection. In Gastrointestinal and Nutritional Manifestations of the Acquired Immunodeficiency Syndrome (ed. Kotler, D. P.), pp. 1–16. New York: Raven Press.Google Scholar
Kotler, D. P., Tierney, A. R., Wang, J. & Pierson, R. N. (1989). Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. American Journal of Clinical Nutrition 50, 444–7.Google Scholar
Kotler, D. P., Tierney, A. R., Brenner, S. K., Couture, S., Wang, J. & Pierson, R. N. (1990 a). Preservation of short-term energy balance in clinically stable patients with AIDS. American Journal of Clinical Nutrition 51, 7–13.CrossRefGoogle ScholarPubMed
Kotler, D. P., Tierney, A. R., Culpepper-Morgan, J. A., Wang, J. & Pierson, R. N. (1990 b). Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome. Journal of Parenteral and Enteral Nutrition 14, 454–8.Google Scholar
Kotler, D. P., Wang, J. & Pierson, R. N. (1985). Body composition studies in patients with acquired immunodeficiency syndrome. American Journal of Clinical Nutrition 42, 1255–65.CrossRefGoogle ScholarPubMed
Kotler, D. P., Tierney, A. R., Ferraro, R., Cuff, P., Wang, J., Pierson, R. N. & Heymsfield, S. B. (1991). Enteral alimentation and repletion of body cell mass in malnourished patients with AIDS. American Journal of Clinical Nutrition 53, 149–54.CrossRefGoogle Scholar
Leiter, L. A. & Marliss, E. B. (1982). Survival during fasting may depend on fat as well as protein stores. Journal of the American Medical Association 248, 2306–7.CrossRefGoogle ScholarPubMed
Melchior, J. C., Salmon, D., Rigaud, D., Leport, C., Bouvet, E., Detruchis, P., Vilde, J. L., Vachon, F., Coulaud, J. P. & Apfelbaum, M. (1991). Resting energy expenditure is increased in stable, malnourished HIV-infected patients. American Journal of Clinical Nutrition 53, 437–1.CrossRefGoogle ScholarPubMed
Mukau, L., Talamini, M. A., Sitzmann, J. V., Burns, C. & McGulre, M. E. (1992). Long-term central venous access vs. other home therapies: complications in patients with acquired immunodeficiency syndrome. Journal of Parenteral and Enteral Nutrition 16, 455–9.Google Scholar
Olmsted, L., Schrauzer, G. N., Flores-Arce, M. & Dowd, J. (1989). Selenium supplementation of symptomatic human immunodeficiency virus infected patients. Biology of Trace Elements Research 20, 59–65.Google Scholar
O'Sullivan, P., Linke, R. A. & Dalton, S. (1985). Evaluation of body weight and nutritional status among AIDS patients. Journal of the American Dietetic Association 85, 1483–4.CrossRefGoogle ScholarPubMed
Ott, M., Lembcke, B., Fischer, H., Jager, R., Polat, H., Geier, H., Rech, M., Staszeswki, S., Helm, E. B. & Caspary, W. F. (1993). Early changes of body composition in human immunodeficiency virus-infected patients: tetrapolar body impedance analysis indicates significant malnutrition. American Journal of Clinical Nutrition 57, 15–19.Google Scholar
Pillar, B. & Perry, S. (1990). Evaluating Total Parenteral Nutrition. Program on Technology and Health Care, Department of Community and Family Medicine, Georgetown University School of Medicine, Washington, D. C.Google ScholarPubMed
Raiten, D. J. (1991). Nutritional and HIV Infection: a Review and Evaluation of the Extant Knowledge of the Relationship between Nutrition and HIV Infection. Bethesda: Life Sciences Research Office, Federation of American Societies for Experimental Biology. Nutrition in Clinical Practice, no. 6, 1–94.Google Scholar
Rakower, D. & Galvin, T. A. (1989). Nourishing the HIV-infected adult. Holistic Nutrition Practice 3, 26–37.CrossRefGoogle ScholarPubMed
Raviglione, M. C., Battan, R., Pablos-Mendez, A., Aceves-Casilla, P., Mullen, M. P. & Taranta, A. (1989). Infection associated with Hickman catheters in patients with acquired immunodeficiency syndrome. American Journal of Medicine 86, 780–6.CrossRefGoogle ScholarPubMed
Redfield, R. R. & Burke, D. S. (1988). HIV infection: the clinical picture. Scientific American 259, 90–100.CrossRefGoogle ScholarPubMed
Resler, S. S. (1988). Nutrition care of AIDS patients. Journal of the American Dietetic Association 88, 828–32.Google Scholar
Rombeau, J. L. & Caldwell, M. D. (1990). Clinical Nutrition: Enteral and Tube Feeding, 2nd edn.Philadelphia: W. B. Saunders.Google Scholar
Schwartz, J. H. & Bistrian, B. R. (1990). The role Of cytokines in intermediary metabolism. In Cellular and Molecular Aspects of Endotoxin Reactions (ed. Nowotny, A., Spitzer, J. J. & Ziegler, E. J.), pp. 427–45. Amsterdam: Elsevier.Google Scholar
Seidner, D. L., Mascioli, E. A., Istfan, N. W., Porter, K. A., Selleck, K., Blackburn, G. L. & Bistrian, B. R. (1989). Effects of long-chain triglyceride emulsion on reticuloendothelial system function in humans. Journal of Parenteral and Enteral Nutrition 13, 614–19.Google Scholar
Shanbhogue, R. L. K., Nompleggi, D., Bell, S. J. & Blackburn, G. L. (1989). Nutritional support in surgery of the liver. In Surgery of the Liver (ed. McDermott, W. V.), pp. 497–510. Boston: Blackwell Scientific Publications.Google Scholar
Shils, M. E. (1990). Nutrition needs of cancer patients. In Nutrition Management of the Cancer Patient (ed. Bloch, A. S.), pp. 3–10. Rockville: Aspen Publishers.Google Scholar
Singer, P., Rothkopf, M. M., Kvetan, V., Kirvela, O., Gaare, J. & Askanazi, J. (1991). Risks and benefits of home parenteral nutrition in the acquired immunodeficiency syndrome. Journal of Parenteral and Enteral Nutrition 15, 75–9.CrossRefGoogle ScholarPubMed
Singer, P., Rubinstein, A., Askanazi, J., Calvelli, T., Lazarus, T., Kirvela, O. & Katz, D. P. (1992 a). Clinical and immunologic effect of lipid-based parenteral nutrition in AIDS. Journal of Parenteral and Enteral Nutrition 16, 165–7.CrossRefGoogle ScholarPubMed
Singer, P., Katz, D. P., Dillon, L., Kirvela, O., Lazarus, T. & Askanazi, J. (1992 b). Nutritional aspects of the acquired immunodeficiency syndrome. American Journal of Gastroenterology 87, 265–73.Google Scholar
Smith, P. D. (1992). Gastrointestinal infection in AIDS. Annals of Internal Medicine 116, 63–77.Google Scholar
Stein, T. P., Nutinsky, C., Condolluci, D., Schluter, M. D. & Leskiw, M. J. (1990). Protein and energy substrate metabolism in AIDS patients. Metabolism 39, 876–81.CrossRefGoogle ScholarPubMed
Studley, H. O. (1936). Percentage of weight loss: a basic indicator of surgical risk in patients wih chronic peptic ulcer. Journal of the American Medical Association 106, 458–60.CrossRefGoogle Scholar
Task Force on Nutrition Support in AIDS (1989). Guidelines for nutrition support in AIDS. Nutrition 5, 39–46.Google Scholar
Trujillo, E. B., Borlase, B. C., Bell, S. J., Guenther, K. J., Swails, W., Queen, P. M. & Trujillo, J. R. (1992). Assessment of nutritional status, nutrient intake, and nutrition support in AIDS patients. Journal of the American Dietetic Association 92, 477–8.Google Scholar
Veterans Affairs Total Parenteral Nutrition Cooperation Study Group (1991). Perioperative total parenteral nutrition in surgical patients. New England Journal of Medicine 325, 525–32.Google Scholar
Waites, L. & Mello, L. (1991). Long-term parenteral nutrition support in a 30-year-old man. AIDS Patient Care 06, 60–1.CrossRefGoogle Scholar
Ziegler, T. R., Young, L. S., Benfell, K., Scheltinga, M., Hortos, K., Bye, R., Morrow, F. D., Jacobs, D. O., Smith, R. J., Antin, J. H. & Wilmore, D. W. (1992). Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. Annals of Internal Medicine 116, 821–8.CrossRefGoogle ScholarPubMed
Zimmaro, D. M., Rolandelli, R. H., Koruda, M. J., Settle, R. G., Stein, T. P. & Rombeau, J. L. (1989). Isotonic tube feeding formula induces liquid stool in normal subjects: reversal by pectin. Journal of Parenteral and Enteral Nutrition 13, 117–23.CrossRefGoogle ScholarPubMed