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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Wasting is a common manifestation of AIDS that diminishes quality of life and is predictive of death. Body composition changes can occur in asymptomatic HIV infection, suggesting that early detection and treatment could potentially prevent the downward spiral to serious wasting. Bioelectrical impedance analysis (BIA) is a method for estimating body composition that is gaining widespread use among HIV-infected populations. In this article, the principles underlying BIA and its appropriate applications and limitations in HIV/AIDS are described.
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PMID:Bioelectrical impedance analysis (BIA) in HIV infection: principles and clinical applications. 943 67

AIDS is often associated with growth retardation in children and wasting in adults. The dissociated envelope protein of the HIV (HIV-1), gp120, can be found in significant concentrations in the parenchyma and cerebrospinal fluid of brains in infected individuals, even in the earliest stages of HIV-1 disease. On the basis of this and the fact that we observed pentapeptide sequence homology between GH-releasing hormone (GHRH) and the V2 receptor-binding region of gp120, we initiated experiments to determine whether gp120 could affect GH secretion and growth in vivo and/or interact with anterior pituitary GHRH receptors in vitro. Although acute IV administration of gp120 in conscious rats had no effect on plasma GH levels, acute administration of gp120 (400 ng) into the brain significantly suppressed pulsatile GH release over a 6-h period compared with saline-injected controls. Furthermore, the putative gp120 antagonist, Peptide T (DAPTA), prevented the suppression of GH by gp120. In support of these in vivo findings, gp120 also significantly (P < 0.05) suppressed GHRH-stimulated GH release in static cultures of dispersed pituitary cells and from cells undergoing perifusion with the peptides. DAPTA prevented the GH suppression by gp120 in both of the pituitary cell paradigms. Furthermore, chronic administration of gp120 into the third ventricle significantly reduced body weight in juvenile rats, compared with saline-injected controls. Thus, gp120 appears to act both at the hypothalamus and pituitary to suppress GH release, and its action at these two locations is associated with a significant loss in body weight in chronically treated young animals. These findings may suggest a specific mechanism for the pathogenesis of wasting in HIV-1 patients that involves blockade of endogenous GHRH receptors by gp120.
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PMID:HIV gp120 inhibits the somatotropic axis: a possible GH-releasing hormone receptor mechanism for the pathogenesis of AIDS wasting. 946 19

The nutritional status of 1854 children under 5 years of age attending 3 maternal-child health clinics in Dar es Salaam, Tanzania, was assessed in an anthropometric study conducted in 1993-94. Clinic attendance declined markedly after 2 years of age. Overall, 31.6% of children were stunted, 14.6% were underweight, and 2.9% were wasted, with higher prevalences among girls. The highest percentage of stunting and wasting was observed among children in the 11-25 and 36-40 month age groups. Peak stunting and wasting occurred at 12 months for girls and 18 months for boys; the decline from peak was faster among boys than girls. Of the 849 children tested for HIV, 14 (1.7%) were seropositive. Both HIV seropositivity and low birth weight were associated with stunting and wasting (odds ratios, 2.8 and 3.61, respectively); breast feeding was protective against stunting and wasting (odds ratio, 0.8). These findings confirm malnutrition continues to be a major problem among small children in Dar es Salaam and suggest a need for special malnutrition control interventions that target this population.
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PMID:Nutritional status of under fives attending maternal and child health clinics in Dar es Salaam, Tanzania. 948 98

Thirty-three patients referred to a wasting clinic were evaluated to assess whether levels of HIV RNA were related to the magnitude of prior weight loss. Their median RNA level was 46,887 gene copies/ml (range, <200-510,070 gene copies/ml) at the time of referral. Patients had lost 10.5 +/- 6.4 kg over 461 +/- 304 days. RNA levels were correlated with the absolute amount and percentage of weight lost as well as the difference in body mass index (BMI) at the prior maximal and minimal recorded weights (r = 0.7, 0.67, 0.69; p = .0001 for the comparisons). The magnitude of these changes increased across strata of HIV RNA levels (p < or = .004), previously defined as associated with increasing risk for disease progression. The other parameter that could be associated with weight loss was the CD4 lymphocyte count (r = -0.43; p = .01). Low levels of testosterone and measures of body cell mass, fat free mass, or fat mass within 6 weeks of the RNA level could not be related to weight loss, change in BMI, or RNA levels. Thirty-two of the patients had chronic, relentless weight loss; in 15 of these subjects, no apparent secondary opportunistic complications were associated with weight loss or gastrointestinal symptoms to impair energy intake. Levels of HIV replication appear to be causally related to the magnitude of weight loss in some patients with wasting.
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PMID:Levels of HIV RNA are quantitatively related to prior weight loss in HIV-associated wasting. 956 43

Mother-to-child rates of HIV transmission are high in Africa. Findings are presented on 62 HIV-positive infants admitted to the Missionaries of Charity Orphanage, Addis Ababa, who were followed from July 25, 1991, to July 30, 1995. The infants were provided with regular clinical examination and treatment by a physician, as well as the monitoring of their HIV serostatus every 3 months until age 18 months and every year thereafter. Among infants over age 18 months, 14 were HIV seropositive and alive, and 4 were HIV positive, but died. 11 children were HIV positive and died before age 18 months and 33 seroreverted to HIV seronegative status. The level of mother-to-child HIV transmission was 29-47%. Among the clinical signs presented, generalized lymphadenopathy, hepatomegaly, splenomegaly, wasting, stunting, and delayed motor development were more often found in the definitely HIV-positive children. Upper respiratory tract infections, acute diarrhea, pneumonia, pyogenic skin infections, sepsis, and candidal infections were the most commonly seen illnesses.
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PMID:A four-year cohort study of HIV seropositive Ethiopian infants and children: clinical course and disease patterns. 957 11

Weight loss and wasting are significant complications of HIV disease. HIV protease inhibitor therapy promotes clinical, immunologic and virologic improvement in HIV-infected patients. In this study, we sought to determine the specific effect of HIV protease inhibitors on patient weight. Ten consecutive HIV patients were treated with protease inhibitor-containing regimens over six months. CD4 T-cell counts, plasma viral load levels and bariatric changes were monitored during the study. Patients experienced a mean weight gain of 19 Pounds (P = 0.006). There was a significant increase in mean CD4 T-cell count (P = 0.008) and a significant decrease in mean viral load level (P = 0.004). The increase in CD4 T cells did not correlate with weight gain, whereas the decrease in viral load did show a significant correlation with the weight increase (P = 0.003). The mechanism of protease inhibitor-induced weight gain is discussed. The medications may also be useful for wasting diseases unrelated to HIV.
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PMID:Weight gain associated with protease inhibitor therapy in HIV-infected patients. 960 7

Wasting is a debilitating complication of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and is a major cause of morbidity and mortality. The etiology of wasting in HIV/AIDS is complex and its origins are multifactorial. Both patterns of simple starvation and the more complex metabolic and endocrine alterations associated with stress and trauma have been described in patients with the AIDS wasting syndrome. Observations suggest that the pathophysiology of the wasting in individual patients with HIV/AIDS may vary according to the primary cause of wasting and underlying disease activity. Optimal treatment of the AIDS wasting syndrome will depend on a thorough evaluation of all possible contributing factors. This review addresses the pathophysiologic basis of weight loss in HIV/AIDS, based on the current literature.
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PMID:The etiology of wasting in the human immunodeficiency virus and acquired immunodeficiency syndrome. 962 88

Recent improvements in the management of people living with human immunodeficiency virus (HIV) disease in the United States have led to remarkable reductions in HIV-related morbidity and mortality. The Centers for Disease Control and Prevention recently reported substantial reductions in acquired immunodeficiency syndrome (AIDS)-related opportunistic infections and conditions, including HIV-related wasting. These achievements followed the introduction of the new class of antiretroviral therapies, the aspartyl protease inhibitors, and their use in combination with nucleoside inhibitors in so-called highly active antiretroviral therapies. In an effort to provide guidance for clinicians in HIV care, the Office of AIDS Research, United States Department of Health and Human Services recently convened a panel of experts to set clinical practice guidelines for the use of antiretroviral therapy in adults and adolescents. This article summarizes the new standard of care for the use of HIV therapies. It also reviews recent data suggesting that combination therapy has altered the natural history of HIV infection and has reduced the incidence of HIV-related nutritional disturbances and wasting.
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PMID:Current antiretroviral therapy and its impact on human immunodeficiency virus-related wasting. 962 90

Findings are presented from a cross-sectional study conducted in 1995 in Bobo-Dioulasso, Burkina Faso, in which the patterns of diseases and CD4 counts among 266 HIV-infected adults of mean age 33 years were analyzed. The bioclinical spectrum of subjects' HIV disease is described and a simple alternative proposed to CD4 enumeration for screening and monitoring HIV-infected Africans. Dermatological symptoms and diarrhea were the most frequent signs associated with B-stage disease, while cachexia and digestive candidosis were the most frequent AIDS-defining diseases (ADD). Peripheral facial paralysis and cutaneo-mucous diseases were associated with weak immune deficiency. Pulmonary tuberculosis (TB) was close to B-stage diseases, and chronic diarrhea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). 90% of CDC C-stage subjects had CD4 counts of less than 350 per mcl, while only 75% had CD4 counts under 200/mcl. Regression analysis identified the lymphocyte count, clinical stage, and platelet count as predictors of CD4 count below 350/mcl. A lymphocyte count of less than or equal to 2500/mcl and clinical stage of B or higher is proposed to determine the CD4 threshold and to determine those patients in need of treatment to prevent wasting and opportunistic infections.
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PMID:A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data. 970 95

Weight loss is significant in patients with HIV and chronic diarrhea. The aim of our study was to test for the links between weight loss, the level of food intake, and the severity of diarrhea and nutrient malabsorption. One hundred and sixteen patients with HIV and chronic diarrhea underwent a standardized gastrointestinal and nutritional evaluation, which included a questionnaire on diarrhea, a prospective estimation of food intake, a measurement of blood parameters and fecal lipid and nitrogen outputs, a stool examination for bacteria and parasites, and upper and lower digestive tract endoscopy. Diarrhea resulted from an infection by Cryptosporidia, Microsporida, or other pathogens in 22%, 20%, and 13% of the patients, respectively. Diarrhea appeared idiopathic in 45% of the patients. A significant negative correlation existed between the severity of weight loss and the levels of nutrient intake (p < .005), and a significant positive correlation between the severity of weight loss and stool frequency (p < .01). Multiple linear regression identified low caloric intake and high stool frequency as predictive of weight loss. No significant correlation was found between weight loss and the parameters of malabsorption, either by bivariate study or multiple regression. These results suggest that, in patients with HIV and chronic diarrhea, the degree of wasting is significantly related to the levels of dietary intake and the clinical severity of diarrhea, but not to the extent of nutrient malabsorption.
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PMID:Factors of weight loss in patients with HIV and chronic diarrhea. 1042 18


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