Canadian AIDS Treatment Information Exchange (CATIE) TreatmentUpdate48, Vol. 4, No. 8 - March 1994
Sean Hosein

At some point during the course of HIV infections patents can expect to lose weight without trying. At firsts the loss of a few pounds or kilograms will not seem important. Over time, however, if weight loss continues it can affect quality of life and survival. Here are some factors which may play a role in unintentional weight loss in people with HIV/AIDS (PWAs):

- loss of appetite - a decreased ability to absorb nutrients from food - altered energy cycles - physical changes to the intestines

STUDYING WEIGHT LOSS

Some doctors studying HIV-related weight loss looked at "changes in [large] groups over fine rather than in individuals..." This type of research has confirmed that weight loss is generally a problem for PWAs. This research does not always easily identify "patterns of weight changes [within a person with HIV/AIDS]." A recent research project in England has confirmed the problem of weight loss and also that there are different patterns of weight loss in PWAs.

STUDY DETAILS

The study monitored 30 male subjects with AIDS for between 9 and 49 months. At least half of the subjects were monitored for 19 months. For this study the researchers looked at weight changes only if they were 4 kg or more. The researchers found that there were two basic patterns of weight loss.

RESULTS PATTERN 1

In this group the subjects had "phases of rapid, severe weight loss within a period of 4 weeks or less." This type of weight loss often happened before a life-threatening infection developed or death occurred. The life-threatening infections seen included: "PCP, [complications caused by] CMV, [fungal] meningitis, tuberculosis, Salmonella and various bacterial infections." Most of these infections did not affect the intestines. Some of those subjects who had this weight loss but survived eventually stopped losing weight or even regained it. The life-threatening infections seemed to alter energy cycles in the body, thus increasing the need for food. Yet these patients did not eat an increased amount of food, indeed some patients ate even less food because they had lost their appetites.

RESULTS PATTERN 2

Subjects in this group had continuous weight loss. Many of these subjects had intestinal infections and diarrhea. This difference between pattern 1 and pattern 2 patients was statistically significant, that is, not likely due to chance alone. In these patients, chronic intestinal infections and diarrhea resulted in the patients absorbing fewer nutrients. This malabsorption was documented by means of various laboratory tests.

EXPECTATIONS

Many doctors and their patents expect weight loss once patients are diagnosed as having AIDS. Despite these expectations the researchers found that some patients had stable weight or even increased weight lasting as long as 10 months.

A WARNING ABOUT FALSE CLAIMS

The researchers found that most of the patients who survived a life-threatening infection gained weight without using any appetite stimulants or food supplements. Just treating the infection alone was enough to get the body to maintain or increase weight. The researchers warn that manufacturers of HIV/AIDS drugs may claim that their products can reduce weight loss or even help increase weight. The study doctors suggested caution when evaluating these claims because of their findings. As wells the researchers noted weight gain and increases in muscle tissue have happened in patients who have been treated for (as an example) their CMV Infection. This increase happened even though the patients were not using any special appetite stimulants.

WHAT NEXT?

Based on their research the doctors suggest that:

- "aggressive nutritional support" may be needed during and after recovery from life-threatening infections to help maintain and increase weight.

- long-term nutritional support should be given to patients with "gastrointestinal" infections/disorders. Nutrients should be given in a form that is relatively easy to absorb and does not further irritate the intestines.

In a commentary on this research, Doctors Carl Grunfeld and Ken Feingold, who have also been conducting their own research in the field of nutrition and HIV/AIDS, state:

- regular monitoring of a patient's weight on an accurate scale is very important. The patient should be weighed wearing the same amount of clothes at every visit.

- Doctors/nurses should have the patient's weight drawn on graph paper. When patients who have been maintaining their weight have a sudden and rapid loss of weight doctors should begin to look for possible infections. This graph "could serve as an early warning" for possible infections.

- "When weight slowly drifts down over long periods of time", doctors should look for an intestinal infection. They also point out that malnutrition can occur even when patients appear to be well, free of symptoms and have CD4+ cell counts ranging between 400 and 650 cells.

REFERENCES:

1. Macallan DC, Noble C, Baldwin C, et al. Prospective analysis of patterns of weight change seen in stage IV human immunodeficiency virus infection. American Journal of Clinical Nutrition 1993;58:417-424.

2. Grunfeld C and Feingold KR. Body weight as essential data in the management of patients with human immunodeficiency infection and the acquired immunodeficiency syndrome. American Journal of Clinical Nutrition 1993;58:317-318.

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Copyright © 1994 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca