The metabolic response to opportunistic infections in AIDS

AIDS. 1996 Nov;10(13):1529-33. doi: 10.1097/00002030-199611000-00011.


Objective: The metabolic response to AIDS-defining opportunistic infections was examined to provide a logical basis for the management of associated weight loss.

Design: A prospective study of metabolism in AIDS.

Setting: HIV outpatients' department and wards at the Chelsea and Westminster Hospital, London.

Patients: Ten asymptomatic Centers for Disease Control and Prevention stage II HIV-seropositive control subjects and 36 HIV-seropositive patients with a single newly diagnosed and untreated opportunistic infection [10 with microsporidial or cryptosporidial diarrhoea, 10 with Pneumocystis carinii pneumonia, nine with cytomegalovirus enteritis and seven with systemic Mycobacterium avium-intracellulare].

Main outcome measurements: Subjects had measurements of resting energy expenditure using indirect calorimetry and of body composition using dual energy X-ray absorptiometry.

Results: Subjects with protozoal diarrhoea had a decreased resting energy expenditure (P < 0.05) and decreased body fat (P < 0.01). Subjects with P. carinii pneumonia had an elevated resting energy expenditure (P < 0.05). Subjects with systemic M. avium-intracellulare had an elevated resting energy expenditure (P < 0.05) and decreased skeletal muscle mass (P < 0.05). Subjects with cytomegalovirus enteritis had a non-significant elevation of resting energy expenditure with a non-significant loss of both fat and lean tissue.

Conclusion: Subjects with protozoal diarrhoea show a starvation response to infection and subjects with systemic M. avium-intracellulare show a cachectic response. Since there is a variation in the metabolic response to opportunistic infection in AIDS patients, nutritional management should be directed according to the specific cause.

MeSH terms

  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / metabolism*
  • Body Composition
  • Body Mass Index
  • CD4 Lymphocyte Count
  • Cryptosporidiosis / immunology
  • Cryptosporidiosis / metabolism*
  • Cytomegalovirus Infections / immunology
  • Cytomegalovirus Infections / metabolism*
  • Diarrhea / immunology
  • Diarrhea / metabolism*
  • Energy Metabolism
  • Humans
  • Male
  • Microsporidiosis / immunology
  • Microsporidiosis / metabolism*
  • Mycobacterium avium-intracellulare Infection / immunology
  • Mycobacterium avium-intracellulare Infection / metabolism*
  • Pneumonia, Pneumocystis / immunology
  • Pneumonia, Pneumocystis / metabolism*
  • Prospective Studies