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

Track B: Clinical Science

Tu.B.2382 - Tu.B.2387

Tu.B.2382
NUTRITION AND TESTOSTERONE STATUS OF HIV+ WOMEN
Engelson, Ellen S*, Goggin KJ**, Rabkin JG***+, Kotler DP*+. 5. vi. Sc 'e-lt
Hospital Center, **Cornell University, ***New York State Psychial i e oI),, ',t. Columbia
University, NY, NY, USA.
Objective: To determine if there is a relationship between hormon!. 01i tsetnal status
in women similar to the correlation between testosterone depleti, r,:i,iiuition in
HIV-infected men, in whom testosterone replacement promotes l. s - aiid lean
body mass.
Methods: A descriptive cross-sectional survey of a convenience CsI,I,,,i it rflected
women between the ages of 18 and 45 who denied use of illegal i ',limum of I
year. Subjects completed a set of interview and self-administered lque:;m,s Height,
weight and body composition (by bioimpedance analysis) were nei, in,:, n,1l iood was
analyzed forT4 helper cell count and testosterone.
Results:The 56 subjects were 21% White, 45% African-American, i ii. A, 'd 4%
Other. Self-identified sexual orientation was I 3% bisexual, 70% hc:tiro csexual rnd I 8%
Lesbian. Mean age was 36.2 years, SD=5.4.Year of first positive HIV tes-t s td fi-rnm 1986
to 1995, with the median in I1990. Mode of transmission was inje-tin, drug use for 21%,
sexual contact for 61%, and both IDU and sex were possible for I 8'. Six!, ix percent of
subjects met CDC criteria for AIDS. Only I subject weighed less thn 90% of ideal body
weight (IBW), but 39% were overweight (>120% of IBW).Thirteen (23%) lost? 10 lbs
since infection, but 23 (4 I%) reported weight gain. Body cell mass (BCM nva., below 90%
of height, race and gender-specific norms in 25% of subjects.The most freq uert nutritionally-related complaint was gas, bloating or cramps (68.5%), followed b lack of appetite
(61.1 %). Blood analyses were evaluable for 50 subjects.T4 counts ranecd Iionr ) to 553,
with 59% <200.Testosterone levels were below lab normals in 50%. 1 counts did not correlate with % IBW (r2=.07) or BCM/ht (r2=. 13). By Mantel-Haensel c i square, subjects
with low and normal testosterone levels differed significantly for B(Clie cht (p-.05).
Conclusions: Serum testosterone levels are frequently low in pre nienopaus.al HIV+
women as they are in HIV+ men, and low levels are associated wisth,s lrn-utrition defined by
low body cell mass.
Ellen S. Engelson, St. Luke's-Roosevelt Hosp. Center, 421 West 1 1Ith ee-t - Sevices and
Research 1301, NewYork, NY 10025.Tel: [phone] Fax: (212, '- 167670
Tu.B.2383
CHANGE IN BODY WEIGHT (WT) AS A PREDICTOR OF DEATH AND
OPPORTUNISTIC COMPLICATIONS (OC) IN HIV BY HISTORY OF PRIOR OC
Wheeler, David A, Muurahainen N, Elion R, Launer C, Gibert C, Bar t,:si G, for The Terry
Beirn Community Programs for Clinical Research on AIDS (CPCRA), NIAIl), NI1H, Bethesda,
MD, USA.
Objectives: Weight loss is independently associated with an incresAed,k -4f deuth and OC
in HIV infected adults. It is unclear if this relationship is preserved i n t rE wnlh no prior history of an OC.
Methods: Data from 4 CPCRA trials were analyzed using time to e,t i cethods. Baseline
wt was determined at study entry and % wt change at the 4 mc visit wt cllhinge - [4
me wt - base wt]/ base wt x 100). Proportional hazards analyses were perform-ed for the
occurrence of death or any OC subsequent to the 4 month visit. csovi snts i the model
included demographics, wt, %change in wt, CD4 count, Karnofsky si.ore, t r oglobirn, antiretroviral use, and PCP prophylaxis.
Results: Mean follow-up of the cohort with CD4 count <500 cel'on ir, 2 0 yrs.
Summary statistics are presented as: [all participants, those witha hi sor ' 8/,f in C
(HxOC), those with no history of an OC (NHxOC)].Total particIp.srs.= ['%182, 1181,
120 I], CD4 count=[86, 61, 110], wt= [1 59, 154, I 63]. % wt chanyge 1 n os -[-0.2, -0.6,
+0.2], % antiretroviral use=[68, 65, 70], %PCP prophylaxis- [90, 93,86. 7 he relative risk
(RR) of death or an C for those whose wt had changed <-5% % beto"ei r tnd 0% of
baseline wt, compared to those who gained wt (>0%) is presented be".,v Ii the status of
tx of OC.

Results: This cohort had a mean age of 40, mean duration of HIV disease of 5.7 years, and
CD4 count of 253. Eighty percent of the group had at least one gastrointestinal symptom.
The miean weight loss from baseline to initial visit (median 7 month interval) was 7.6
pounds, while that f-rom initial to follow-up GIN clinic visit (median 2.5 month interval) was!.4 pounds. Multivariable linear regression techniques were used to evaluate significant predictors of percent weight loss from baseline weight to the time of the initial visit. Significant
factors included the presence of anorexia or diarrhea, low initial TSF, and CD4 count (F statistic = 20.5, R-squared = 0.56, dependent variable p-values < 0.01 ).The presence of
anorexia or diarrhea correlated with a weight loss of 9.0 and 6.7 pounds respectively.
Analysis of the subgroups of patients by CD4 count (greater or less than 200), and by
weight loss (absence/presence, greater/less than 5%) yielded consistent results.
Conclusions: VWeiglht loss in individuals with "early HIV disease" is consistent with simple
starvation, i.e. loss of fat stores and preservation of muscle mass.The presence of gastrointestinal symptoms, specifically anorexia and diarrhea, and low fat stores(TSF) correlate with
weight loss in early HIV disease prior to opportunistic infection. Laboratory evaluation, and
the protein and caloric intake based on three day diet record do not predict weight loss.
Douglas Morgan. Div. of GI, NH 3D-4, San Francisco General Hospital 100 I Potrero Ave,
Sanri Francisco, CA 94110, USATel: (4 15) 206-4753 Fax: (415) 641- I 0745 Email:
hannes(dsitsa.ucsf.edu
Tu.B.2385
FREE TESTOSTERONE AS A PREDICTOR FOR BODY COMPOSITION CHANGES IN
MALES WITH HIV OR AIDS
Seversonthirae, Nemechek, Patrick. Center for Special Immunology, P 1 airie Village.
Kansas, USA
Objective: To comspare the relative serum levels of total testosterone (TT) versus free
testosterone (FT) levels in patients with HIV and AIDS and associated bioimpedance pararmeters (BIA. RJL Systems). Secondly to determine if serum HIV RNA (bDNA, Chiron
Corp.) and CD4 counts are associated with hypotestosteronemia (HT).
Methods: HIV-RNA, total CD4, CD4%,TT and free FT levels and bioimpedance evaluations
were performed on forty-five homosexual males, with HIV or AIDS, during their initial clinic
assessment. Body cell mass (BCM), body fat (BF), and phase angle (PA) were obtained from
BIA evaluation. Unpaired T-tests were run between patients with normal and low FT and
between low FT and HIV-RNA, CD4 count, CD4%, as well as the mentioned BIA parameters.
Results: This study revealed that 43% of the patients in the study had decreased levels of
FT IfTT levels been used for criteria of HT, 63% of the patients with low FT would have
not have been diagnosed with HT Patients with decreased FT tended to have relatively
lower total CD4 and CD4%, but did not prove to be significant (p =.42 and.22). A correlation between decreased FT and increase in viral load did not exist (p = 0.88).
PA was significantly lower (5.0 vs. 6.27, p =.002) in the individuals with decreased FT compared to patients with normal FT levels.The normal FT patients had more BF than the deficient FT group by approximately 3% (p=.02). BCM were equal in both groups (p=.950).
Conclusion: HT has been shown to cause protein wasting in HIV negative individuals. In
our patient population, testosterone deficiency was quite frequent and associated with a significant decrease in PA. PA measurements below 4.8 ~ 0.7 have been shown to be an independent predictor of HIV progression (Ott et al. 1995). Additionally FT seems to be superior in detecting HTThere was no detectable difference with HT in BCM, viral load and
CD4, however our small sample size may not be powerful enough to detect these differences and should be further evaluated.
KR Severson, 730t1 Mission Road, Suite 339, Prairie Village, Kansas,66208 USA Telephone:
8! 6-384 7307 Fax: [phone], email: KRSevertAOL.COM
Tu.B.2386
THALIDOMIDE ASSOCIATED WEIGHT GAIN IN HIV- I (+) CLIENTS
Sharp Mat etthew Gey J**, Chambers S* S ekeres G.. "Healing Alternatives Foundation,
SF, CA, USA: * "ACT UP Golden Gate, SF, CA. USA
Objective: To evaluate the usefulness of the tumor necrosis factor-alpha inhibitor thalidomirde for weight gain in HIV- I (+) clients buying the drug at a community based organiza
\ % wt change RR of Death
0: (relative to >0% all HXOC NHXOC

RR of anyOC
all HxOC NHvOC

<-5%
0 to -5%

2.321 2.441 2.631 1.881
1.262 1.461 1.06. I 2
I=p<_0.001'.2=,,C

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4)
C
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C
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332

Conclusion: Weight loss of more than 5% over 4 months is assoc:iat
risk of death and OC even in those individuals with no prior histor
David A.Wheeler 29 South Greene St. Rm 226, Baltimore, MD, I SA.
5725, Fax: [phone], e-mail: dwheeleq)hiv.ab.umd.edu
Tu.B.2384
PREDICTORS OF WEIGHT LOSS IN EARLY HIV DISEASE
Morgan, Douglas R., MH Steuerwald,YL Garcia-Shelton, MK Scott I I
Koch. Division of Gastroenterology, Department of Medicine, Sari f s
Hospital, UCSF.
Purpose: Wasting is a major clinical feature in the majority of patiner'sts.
some point in their illness.We used multivariable linear regression te
clinical factors which might be predictive of patients at risk for weighlt
patients with early HIV disease.
Methods: We reviewed 105 HIVinfected patients in a large hospit l
Nutrition(GIN) clinic. Early HIV disease was defined by the absence,
(AIDS-defining) opportunistic infection; 60 patients and 45 patient(,,
than and less than 200, respectively Clinical evaluation included the i,
symptoms (anorexia, nausea, diarrhea, dysphagia, odynophagia, abdcn
metric measures (triceps skin fold(TSF) reflecting body fat stores. s, ril
ence(MAMC) reflecting lean body mass), laboratot y measures (aId-,,n
terol, triglycerides, zinc), and nutritionist's assessment (three day hes
intake, protein intake).The individuals usual body weight was corpsn
clinic visits.

tion.
1.86 1.951 Methods: Since August 15, 1995, 205 HIV- I (+) clients were surveyed monthly by mail
I 22 1. 19 about demographics, medical history, current symptoms, quality of life and body weight.
si, - - Results: Sixty nine (34%) of clients returned the baseline questionnaire. Sixty-eight (99%)
were male, mean age (+/- SE) 42.2+/-0.9 years (range =29-67), 42 (61%) had a diagnosis
d vs i an increased of wasting and 13 (19%) had apthous ulcers. Of those reporting at I month (n50) the
0i In Ca mean percent weight gain-MPWG-from baseline was 2.6+/-0.5% (p<0.0001); at 2 months
(n=26) MPWG was 3.4+/-. I.1% (p<0.005); and at 3 months (n= 10) MPWG was 5. I +/
lelci hone: (410) 328- 2.4% (p<0.06). Clients who reported weight loss at > I month discontinued drug because
of lack of availability (n-4) or adverse effects (n=2). Clients reported a significant increase
in appetile and quality of life score (p<0.0006 and p<0.002, respectively). In these reporting
clients, the prevalence of neuropathy, rash, dry mouth, constipation and drowsiness were
not increased over baseline.The median daily dosage of thalidomide taken was 100 mg.
1 -,'sse rr;,rn, JP Cello, J Data is currently unavailable on non-reporting clients.
ris I, (jieneral Conclusions: These results must be interpreted with caution since they are limited to the
subset of clients reporting. Use of thalidomide in these clients was associated with a signifisth tIlV disease at cant and persistent increase in body weight which diminished when drug was discontinued.
sc'. ti examine The drug was well tolerated with improvements in appetite and quality of life without any
Ic-;s in i cohort of increase in adverse effects over baseline.The study is ongoing and further analyses are
underway

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M. Sar p, 1748 Market Street, Suite 205, San Francisco, CA 94102 Tel.: [phone] Fax
-115-626-0451 email haft out.org
Tu.B.2387
MULTIPLE ABNORMALITIES IN LIPID AND CARBOHYDRATE METABOLISM IN MEN
WITH AIDS-WASTING SYNDROME (AWS): INTER-INDIVIDUAL VARIABILITY,
PATHOPHYSIOLOGIC MECHANISMS AND PROGNOSTIC SIGNIFICANCE
Hetllerstein, Marc K, Neese R, Papageorgopoulos C, Hoh R. University of California, San
Francisco, CA and University of California at Berkeley CA, USA.