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Biological Relationship Between HIV and Nutrition Christine Wanke , MD

Biological Relationship Between HIV and Nutrition Christine Wanke , MD. Malnutrition in HIV. Intestinal injury. Malabsorption. Increased risk for enteric pathogens. Diarrhea. Further Immune Dysfunction. Malnutrition. Weight loss pre-ART.

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Biological Relationship Between HIV and Nutrition Christine Wanke , MD

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  1. Biological Relationship Between HIV and NutritionChristine Wanke, MD

  2. Malnutrition in HIV Intestinal injury Malabsorption Increased risk for enteric pathogens Diarrhea Further Immune Dysfunction Malnutrition

  3. Weight loss pre-ART • Death associated with weight less than 66% of ideal body weight • Death associated with lean body mass falling below 54% • Independent risk factor for death in HIV • Weight loss also associated with increased risk for hospitalization, decreased quality of life • Increased progression of HIV • As little as 5% weight loss was associated with mortality and increased risk of opportunistic infection .. Chlebowski RT, 1989; 6. Guenter P, 1993; Palenicek JP, 1995;.Cohan GR, 1992. Turner J, 1994.Wheeler DA, 1996, Wilson

  4. BMI and Survival in HIV in South India, n=3262 Saghayam, unpublished 2008

  5. Unintentional weight loss and mortality in ART treated (US) Tang, 2002

  6. Nutritional status at initiation of ART: association with mortality Paton 2006, Stringer 2006, Zaccharia 2006, Johannsesen 2008

  7. Weight Loss and Survival in Era of ART: Adapted from Tang AM, et al. JAIDS. 2002;31:230-236.

  8. Etiology of Weight Loss in HIV: • Inadequate Caloric Intake • Symptoms • Access to food/ food security • Malabsorption/ diarrhea • Altered Metabolism • HIV • Opportunistic Infections

  9. Frequency of Symptoms that may Contribute to Nutritional Compromise in HIV Infection in South India Saghayam, unpublished

  10. Prevalence of Intestinal Dysfunction in HIV in South India R. Isaac, unpublished

  11. Change in body weight and BMI by categories of change in viral load: untreated HIV Weight (p<0.001) BMI (p<0.001) Mwamburi et al 2004

  12. Nutritional Status in HIV Positive (Advanced and Early Disease) and HIV Negative Individuals in South India Saghayam unpublished

  13. Does 6 months of ART Improve Nutritional Status in HIV in India? • 190 HIV-infected patients initiating HAART in Chennai, South India at YRG CARE • Mean age 35 years (range 20-62 years) • 85% male • Overall body weight increased mean 2.8 kg (range –12.5-22.5 kg) • 41 (22%) lost weight (>1 kg) • 37 (19%) were weight stable (change < 1 kg) • 112 (59%) gained weight (> 1 kg) Saghayam, unpublished

  14. Impact of Treatment of HIV: Anthropometric Parameters after 6 months on HAART in South India

  15. Impact of Opportunistic Infections on Nutritional Parameters in South India

  16. Summary • Weight loss in HIV is associated with morbidity and mortality • Whether or not on ART • Weight loss is likely multifactorial • Response needs to consider etiology • Treatment of HIV • Treatment of OIs (TB) • Control of symptoms

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