Metabolic and Morphologic Complications of HIV and HAART

• PI therapy is associated with weight gain^{1, 2}

• Gain is fat mass with no change in LBM^{1, 2}

• Viral load and HAART exert independent effects on resting energy expenditure (REE)³

• HAART is associated with increases, decreases, or no changes in REE^3-6

1. Silva M et al. AIDS. 1998;12:1645-51.
2. Pernerstofer-Schoen H et al. AIDS. 1999;13:2389-96.
3. Shevitz AH et al. AIDS. 1999;13:1351-7.
4. Mulligan K et al. N Engl J Med. 1997;336:70-1.
5. Carbonnel F et al. AIDS. 1998;12:1777-84.
6. Sherer R. Semin Oncol. 1998;25(2 Suppl 6):92-7.

• Several other studies have examined the effect of HAART on weight and body composition.

• While patients who are on PI-containing regimens gain weight, it is mainly in fat mass, with no change in lean body mass.1, 2

• In terms of resting energy expenditure, viral load and HAART appear to exert independent effects.3 HAART may decrease the metabolic rate by lowering viral burden. However, it also increases metabolic demands by another mechanism independent of the viral burden effect. As such, patients may have elevated resting energy expenditures despite adequate control of viral load.

• Other studies have shown that HAART is associated with increases, decreases, or even no changes in resting energy expenditure.3-6

References:

1. Silva M, Skolnik PR, Gorbach SL et al. The effect of protease inhibitors on weight and body composition in HIV-infected patients. AIDS. 1998;12:1645-51.

2. Pernerstorfer-Schoen H, Schindler K, Parschalk B et al. Beneficial effects of protease inhibitors on body composition and resting energy expenditure: a comparison between HIV-infected and non-HIV-infected patients. AIDS. 1999;13:2389-96.

3. Shevitz AH, Knox TA, Spiegelman D et al. Elevated resting energy expenditure among HIV-seropositive persons receiving highly active antiretroviral therapy. AIDS. 1999;13:1351-7.

4. Mulligan K, Tai VW, Schambelan M. Energy expenditure in human immunodeficiency virus infection. N Engl J Med. 1997;336:70-1.

5. Carbonnel F, Maslo C, Beaugerie L et al. Effect of indinavir on HIV-related wasting. AIDS. 1998;12:1777-84.

6. Sherer R. Current antiretroviral therapy and its impact on human immunodeficiency virus-related wasting. Semin Oncol. 1998;25(2 Suppl 6):92-7.