Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track B: Clinical Science

Tu.B.2246 -- Tu.B.225 I

Tu.B.2246
WHEN WHY AND WHOM ENTERAL NUTRITIONAL SUPPORT(ENS) IN AIDS
WASTING SYNDROME OF AIDS AND IN THE EARLY HIV DISEASE.
Mora Rodriguez, Gabriela., Feregrino-Goyos,M., Gomez=Caro,WH., Eid Lidt, G., /\lvaradoDiez, R., Gallegos-Perez, H. CITAID (Center for reasearch and AdvasaredI etcr It in
Immunedefficiency, S. C.) Hospital de Especialidades Dr Bernardo Sepulveda rdel CMN S
XXIIMSS, M6xico D.F. MEXICO.
Objectives: The Nutritional Enteral Suppport complementary or total (NE5), increase the
quality of life of the HIV patients We want to deterninate whom ENS supplen ntary
increase most better survive, lean nass, and diminished the O.I. incidene and increase the
effect of antiviral trieatments in both advanced and early HIV+ patients wi h wvastinr
Syndrome.
Methods: We studied 380 HIV advanced patients.The control group waos rnmed for 100
patients with antivirics treatments and rutinal prophilactic of O.I. but without NS. (group
4).In other 280 HIV patients with wasting we studied 4 different NES forrsulais. Group
I (I 10 patients) received polymeric diet(ensure,sustacal).The group 2 with 50 patients,
received Elemental diet (VIVONEX HP), Group 3a with 20 patients iecrved irnmunonutrition diet(IMMU NAID).The group 3b with 100 patients received Specist diet (Advera). All
the patients receive antibiotics and antiviral treatment.We analyzed with parametric and
non parametrics methods, antrophonmetric measures(MCA,TP and weight), Karnofsky Index.
survive, new O.I. events, Lymphocytes total count, CD4,CD8, CD4/CD8 index. mortality
average. The cuts were at 90, 180,270 and 360 days..
Results: The great mortality average was in the cotnrol group 33% at 90 days, 56% at 180
85% at 270, and 99% at 360 days.THe ENS decrease the average of mortality at the sarme
time. At 360 days were 40% in group I. In group 2: 72%, group 3A 28%, group 3B 19%.
The anthropometric measured, the Karnofsky index increase, count ofTotal lyrnphocytes,
got better and had less events of O.1., in comparation to control group (pI<0.05) in each
parametei
Conclusion:The enteral nutritional support improved the antiviral treatments in AIDS and
HIV+ patients, and reduced the mortality and O.I. complications.The best option is the
immunonutrition, but the normal diet in advanced AIDS without supplementary NIES had
bad results with the same antiviral and antibiotics treatments.
Gabriela Mora Rodrigues Nutritiornist. address: Alfonso # 162 Col Alamrnos, Mexico DF, CP
03400, Mexico.- ml (525)6/27367 Fax [phone]
Tu.B.2247
DOUBLE BLIND, PLACEBO (PLC) CONTROLLED 6 MONTH STUDY TO ASSESS THE
PROMOTION OF WEIGHT GAIN AND THE EFFECT ON QUALITY OF LIFE OF
MEGESTROL ACETATE (MA) IN HIV SEROPOSITIVE PATIENTS WITH WEIGHT LOSS.
JohnstonSusan*, Clotet B*, Gatell JM**, Podzamczer D***, Gimnez Arnau JiM**5*, Bestit
I***, Gel S*, Diaz B**,Virgili N***, Giro M**. Hospital Universitari "Germans Trias i
Pujol"*; Hospital Clinic**; Hospital de Bellvitge***; Prasfarrna SA** m*; Barcelona. Spain.
Objective: To compare the efficacy of MA vs. Plc in improving nutritional status in HIV
seropositive patients and its effect in quality of life.
Methods: We studied 89 HIV seropositive patients with CD4 < 200/rnm3 and a weight
loss > 5%.The study was randomized, double blind and placebo controlled over a 6 month
period. All patients were evaluated every 2 months.The dosage of MA was 320 mg daily
for 2 weeks every month (2 weeks on and 2 weeks off). Parameters studied were: body
weight (BW), tricipital skinfold thickness (TST), upper arm circumference (UAC), upper arm
muscle circumference (UAMC), mid arm muscle area (MAMA), quality of life (QuL).
Statistical methods used were chi-square test and student t-test.
Results: Both groups were comparable at baseline in all evaluated parameters.Liable i summarizes the nutritional results obtained.

GROUP n Pts Mean CD4 (,nm3) Mean Weight (Kg.) Mean Weight Gain (Kg) Mean Maximum Mean Follow-Up
(Male/Female) BASELINE BASELINE ONE MONTH Weight Gain (Kg.) (Months)

PE.G.

8 iS 12 (.."
(ange- 11i ) (ren,le I lI

CONTROLis 5)8 0>. t-n2 585(, D
(I7!2) (rang} 0-1.40) (; 0v 5 9) (lalln "0 1.8) (raige. 0--4) (ln e. i 8)
Two patienls developed 4 episodes of infections related to the PEG which responded to
aiitilsiotic Loss of weight occurred in patients in terminal illness and acute infections (progression gpra phs will be presented). P G Patients have expressed satisfaction and improved
well bme igwitl increased weight.
Discussion: I. Patieiits correctly selected can achieve weight gain over a long period before
ter iniral stage. 2. So far, PEG feeding is well tolerated and appears effective and safe for
inraproving Body Weight in AIDS patients and achieves better nutritional status than oral
sulplpleenertation over the long term.
Bonaventoa Clotet. AIDS Unit. HOSPITAL UNIVERSITARI GERMANS TRIAS I PUJOL
089 I 6 Badlona, SPAIN TEL: 34-3-'165 I 2 00 EXT 426 or 427 FAX: [phone]
Tu.B.2249
HIV NUTRITION ASSESSMENT AND COUNSELING:A GUIDE FOR PROVIDERS AND
CLIENTS
Kruse, Laura M.*. Fairchild, G.T**. DHHS/tHealth Resources and Services Admin., Bethesda,
MD, USA;* Carmichael, CA, USA.
Issue: The inpor tance of nutrition as an integral part of health care for people with HIV
disease is well documented, yet often overlooked in the provision of early intervention primary health care services.
Project: A nutrition manual which focused on the assessmrent and provision of HIV nutrition guidance, with an emphasis on intervention in early and middle stage disease, was
developed.The manual includes comprehensive nutrition screening and assessment tools to
be used cooperatively by the health care provider and client, as well as short educational
handouts on various nutrition issues for clients. Materials ar e developed at several levels,
from pictorial to more complex for use in various community settings, as well as in Spanish.
Results: The Guide is currently being distributed nationallyThis rnanual provides the practitioner in the coimmunity setting with the necessary resources to provide culturally appropriate, comrprehensive nutrition assessment and counseling throughout the course of HIV diseaise in the absence of, or in conjunction with, a nutritionist.
Lessons Learned: Nutrition is an essential component in the care of HIV-infected individuals, with changes iii nutritional status occurring from the onset of the disease.The need to
address nutritional issues early in the disease process is important to delay the onset of
wasling and improve quality of life.
LMKruse, HRSA/BPHC, 4350 East-West Hwy, Bethesda, MD, USA20814 Telephone: [phone] FAX [phone], email: Ikrusehrsa.ssw.dhhs.gov
Tu.B.2250
ACCURACY OF BODY COMPOSITION MEASUREMENTS BY BIOIMPEDANCE
ANALYSIS IN CHILDREN INFECTED WITH HIV-I
Arpadi. Stephen M,Wang J, Cuff PThornton J, Horlick M, Kotler D, Pierson, R. St. Luke'sRoosevelt Hospital Center, Columbia University, College of Physicians & Surgeons. New
York, NY
Objective: Developing inexpensive, simple, and accurate methods for monitoring nutritional
status is an important area of clinical research for HIV-infected children who commonly
experience growth failure and wasting.The purpose of this study was to assess the performance of bioimpedance analysis (BIA) and standard prediction equations to predict total
body water (TBW) and fat free mass (FFM) in children with HIV
Methods: TBW was measured by deuterium oxide dilution (TBWD20), FFM from dual Xray absorptiornetry (FFMDXA), and BIA using a single frequency bioelectrical impedance
analyzer (RJL 101/A).
Results 'wer ty prepubertal, HIV-infected children, ages 4-I I years, including 9 with growth
failure (decline in height-percentile > 2 SD within 18 mos of study) and 2 with AIDS
Wasting Syndrome (weight loss of _10% of body weight) were included. Most children had
mnoder ate to severe symptoms (Centers for Disease Control HIV Class B or C).The mean
CD4 count was 319/dl (range, 4-1099). Comparison of estimated TBW and FFM using 8
previously published pediatric predicton equations with the measured TBWD20 and
FMDXA resulted in substantial erron r.We developed regression equations using height (H)
and BIA resistance (R) with improved accuracy for prediction as follows:
Log(TBWVD20= I1.65 + 0.05H2(cm)/R(ohms) [r2=.95, SEE=0.068] and
FFMDXA(kg)= 1.3'4 + 0.70Age(yrs) + 0.68H2 (cm)/R(ohms) [r2=.95, SEE- 1.23].
Conclusion: Our results indicate that BIA is a useful method for estimating body composition in HIV-infected children including those with HIV-associated growth failure and wasting.
Values comparable to those obtained by more traditional, expensive, and time consuming
methods are obtained. It appears however; that predictive equations derived specifically
fi-oss this population must be used.
Stephen M. Arpadi, M.D., MSPH; St. Luke's-Roosevelt Hospital Center I I I 1111 Amsterdamn
Avenue, New York, NY USA 10025,Tel: [phone], Fax: [phone]
Tu.B.225 I
VITAMIN A (TRANS RETINOL) IN CONGENITAL HIV PATHOGENESIS
Cunranghan-Rundles S*, Kim S*, Dnistrian A**, Noroski L*, Grassey C*, Hinds G*, Cervia
J*. *Conell hUniveristy Medical College **Memorial Sloan Kettering Cancer Center
Objective: To evaluate the correlation between levels of vitamin A (trans retinol) and
imnune charmg s, progression, or seroreversion in children congenitally exposed to HIV
Methods: Vitamin A was measured as plasrsa trans retinol by HPLC and lymphocyte subsets were assessed by flow cytometry in 21 HIV exposed, seropositive children, and non
exposed, seromnegative controls. HIV exposed children were divided into asymptomatic and
seroreve ters versus symptomatic, infected children. Age ranged fiom one month to four
years in both. Mean age was not statistically different although mean age of the

BASELINE
Group MA Group Plc p value
Mean values (n~ pts)

6 MONTH
Group MA Group Plc p value
Mean values (n pts)

I'0
O\
v
D
0
u
c
V)
0
C
c0
a)
u
C
C
0
r--
c
0
nO
a)
x
308

BW(Kg)
TST(mm)
UAMC(cm)
MAMA(m2)
0oL

57.6 (45)
8. 1 (45)
24.3 (45)
21.8 (45)
38.6 (45)
4.4 (45)

58.9 (44)
7.3 (44)
24.8 (44)
22.6 (44)
41.1 (44)
4.5 (43)

0.47
0.27
0.44
0.21
0.22
0.89

62.1 (21)
9.7 (21)
25.5 (21)
22.5 (21)
40.8 (21)
6.7 (21)

59.2 (23)
7.I (23)
241 (23)
21.8 (23)
1i5 (23)
5.2 (23)

0.28
0.006'
0.11
0.45
0.45
0.04*

Eight patients in PIC group died durin g the follow-up and only our in the MA group.

Discussion: We observed a significant increase in QoL in MA group, a prior ity in the man--
agement of HIV infected patients. Regarding the nutritional paramneters, the increase in TST
was significant. There is also a trend to statistical signification in BW and in UAC.
Susan Johnston. Dietetic Unit. HOSPITAL UNIVERSITARI GERMANSTRIAS I I'UJOL 08916
Badalona, SPAIN TEL: 34-3-465 I2 00 EXT 286 or 427 FAX: [phone]
Tu.B.2248
RESULTS OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (REG.) FEEDING OF
AIDS PATIENTS IN OUR AIDS UNIT.
Clotet, Bonaventura*, Johnston, S**, Alastrue, A***, Boix, J***, Gel S**5, Siresra, G. AIDS
Unit; * Dietetic Unit, * Surgery Department; *** Endoscopy Depar tnment; * H H ospital
Universitari "Germans Trias i Pujol". Badalona. Barcelona. Spain.
Introduction: Nutritional deficiencies, a widespread problem in AIDS, require active intervention as early as possible to prevent further deterioration of nutritional states.Various
studies have described the efficacy of nutritional support via PEG.
Objective: To study the efficacy of ambulatory PEG feeding administered as a nocturnal
supplement in imnproving or maintaining nutritional status in AIDS patients wth sustained
body weight loss compared to a control group.
Methods: AIDS patients (CD4<200) with > 10% weight loss were randomised to receive a
special peptide enteral product (Ross Laboratories) as oral supplements or supplermentation via a PEG as part of a long term study.
Results: Preliminary results: (D - Died.)