Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 32182-32186 557

32182 Preservation of restored body cell mass (BCM) and
phase angle after discontinuation of human growth
hormone (r-hGH; Serostim )
Patrick M. Nemecheck1, Jennifer Stolifer2, Lisa Sackuvich2. 17301 Mission
Road Suite 339, Prairie Village, Kansas 66208; 2The Comprehensive
Immunology Center, Prairie Village, KS, USA
Introduction: Research has emphasized the clinical and nutritional significance
of BCM in HIV Disease (BCM; Kotler et al 1989), and recombinant human Growth
Hormone (Serostim, r-hGH) therapy in AIDS Wasting Syndrome (AWS) patients
(pts; Mulligan et al 1993). This observational long term study provides evidence
on pts with AWS who had BCM restoration with r-hGH therapy and successfully
maintained BCM after r-hGH cessation.
Study: Six pts with AWS were monitored for total body weight, BCM, fat mass,
phase angle (PA), HIV RNA, and CD4 count at 3 months & immediately prior to
r-hGH therapy. Data for these variables were also collected at 1, 3, 6, 9 and 12
months post r-hGH discontinuation. BIA (Bioelectrical Impedance Analysis; RJL
Systems) was used for body composition testing.
Results: R-hGH therapy had to be reinitiated for only one pt secondary to CMV
treatment complications. The pt was excluded from the observation cohort. Of the
5 pts remaining, all preserved sufficient BCM (35%-45% of total body weight). 4
of 5 pts sustained a PA above 5.6 (PA < 5.6 indicates increased risk of death
from malnutrition; Ott et al 1995). Declines in HIV RNA and increases in CD4
count occurred during the 12 month period for all pts. Replacement testosterone
for hypogonadism was initiated for each pt during the duration of this study.
Conclusion: R-hGH therapy in AWS is effective in restoring BCM and some
pts are able to preserve BCM stores after r-hGH cessation. This study refutes
that AWS pts need longterm r-hGH therapy. Specific details of each case will be
presented.
| 32183 Lack of change in body weight and body composition in
HIV+ individuals without wasting who initiate maximally
suppressive antiretroviral therapy
James Hellinger1, B.S. Kim', B. Dionian1, C.J. Cohen1, R. Zackin2. 1CRI of New
England, 320 Washinton St., Brookline, MA; 2Harvard School of Public Health,
Boston, MA, USA
Introduction: Potent antiretroviral therapy may potentially induce changes in
body weight and body composition in persons with or without clinical evidence of
wasting.
Objective: To measure sequential changes in body weight and composition in
HIV+ individuals without wasting who initiate highly active antiretroviral therapy
(HAART).
Methods: HIV+ patients free of acute opportunistic infections were prospectively enrolled for sequential body composition analysis by bioimpedance analysis
(BIA, RJL systems), weight, nutritional assessment at initiation of HAART upon
entry into several clinical studies. BIA was repeated every 6-12 weeks.
Results: A total of 23 men were enrolled and followed for a median of 5
visits over a median of 9.3 months of observation. Mean age was 38 years and
ethnicity included 19 Caucasians, 2 African Americans, and 2 Hispanics. Median
CD4 count at entry was 266 cells/mm3 (range 97-519) and median log plasma
HIV-1 RNA was 5.02, (range 3.1-5.5). 96% were suppressed greater than 1 log
including 48% below detection (<500 copies/ml) by the first visit (week 6) and
87% were suppressed below 500 copies/ml during the period of observation. At
entry into the cohort, patients were somewhat overweight with a median BMI
of 24.3 (range 20.2-30.3) including 3/23 individuals with BMI > 28. Univariate
regression models were used to calculate the rate of change in key parameters
during the period of observation. We detected no significant changes in body
weight, fat free mass, or phase angle. Neither CD4 nor viral load were predictive
of the rate of change of weight, fat-free mass, body cell mass, or phase angle.
Conclusion: In this group of HIV+ men of normal or excess BMI without wasting who initiated highly active antiretroviral combination therapy, no significant
changes in body weight or body composition were evident during the period of
observation. We did not measure blood micronutrient values, metabolic rate, or
other indices that may improve with maximal antiviral suppression.
| 32184 Stool weight is associated with weight loss in patients
with chronic diarrhea
Jamey Maimares Schmidt1, S. Porter2, L. Kim1, M. Keiserman1, M. Holodniy3,
J. Koch1. 1U. C. San Francisco, 1001 Potrero Avenue 3D, San Francisco, CA
94110; 2Shaman Pharmaceuticals, San Francisco, CA; 3AIDS Research Center,
VAPAHCS, Palo Alto, CA, USA
Background: Weight loss and diarrhea are extremely common manifestations of
HIV infection. However, it is unclear whether chronic diarrhea causes clinically
important weight loss.
Methods: Medical records from all patients with HIV-associated chronic diarrhea in whom 24 hour stool collections had been obtained were reviewed.

Two patient cohorts were included, Group A: patients referred to the HIV-Gastroenterology-Nutrition clinic, and Group B: patients with AIDS who volunteered
for an inpatient study unit, anti-diarrhea drug trial in whom pre-treatment stool
weight was recorded. Ideal body weight (IBW) was determined using the Hamwi
equation. Clinically important weight loss was defined as body weight <95% of
ideal body weight. The association between stool weight and age, weight loss,
CD4 cell count and presence of an AIDS defining diagnosis was assessed using

Student's t-test (mean ~ standard deviation) and multivariate linear regression
models.
Results: The 139 patients (134 male) had a mean age of 39.9 years (~7.4),
mean stool weight of 683 grams (~248) and median CD4 count of 170 cells/mm3
(range 2-1330). Of 55 patients in Group A, 18 patients (33%) did not have an
AIDS defining diagnosis. The mean stool weight of patients with weight loss was
significantly higher than for patients without weight loss (856 g ~ 525 vs. 580 g ~
334, p = 0.007). Limiting the anlysis to patients with an AIDS-defining diagnosis
did not change this result. The significant association between stool weight and
low body weight remained after adjustment for age, sex, CD4 cell count and the
presence of an AIDS-defining diagnosis.
Conclusion: The average daily stool weight in patients evaluated with HIVassociated diarrhea exceeds 500 grams/day. Higher stool weights are strongly
associated with clinically important weight loss (>5% below IBW) and are independent of CD4 cell count and the presence of an AIDS-defininfg diagnosis.
Calorie loss secondary to diarrhea is a likely mechanism for weight loss in patients
with HIV-associated chronic diarrhea.
32185 1 Anabolic steroids, resistance exercise and protein
supplementation effect on lean body mass in HIV+
patients
Nelson R. Vergel1 3, P. Salvato2, M. Mooney3. 11112 Jackson Blvd Houston TX
77006; 2Physician, Oncol Medical Group Houston TX; 3Res. Dir., Program for
Wellness Restora Houston, USA
Objectives: To perform a patient chart review to evaluate the effectiveness of
a comprehensive, multifactorial program for increasing lean body mass (LBM)
and quality of life for HIV/AIDS patients. Primary objectives were to determine
changes in BCM (Body Cell Mass) by BIA technology and total body weight.
Secondary goals were to evaluate changes in CD4 and CD8 counts, viral load,
albumin, quality of life and the occurrence of any undesirable side effects.
Methods: A pilot open label study involving a goal of 30 patients was started
in June 1996 to evaluate a comprehensive approach to wasting syndrome. The
program included nutritional counseling and enhanced protein nutrition (42-84
grams a day of a undenatured, lactose free, glutamine enriched whey protein product), resistance weight training (1 hour sessions, 3 times per week),
daily vitamin/anti-oxidant supplementation (OptiPak ), and a 12 week anabolic
steroid program which included the use of 200 mg/week nandrolone decanoate
(Deca-Durabolin"') and 100 mg/week testosterone enanthate (Delatestryl') as
specified by the PoWeR"' program. Baseline CD4 counts ranged from 90 to 528
cells/mm3, CD8 counts ranged from 696 to 1813 cells/mm3, and viral loads ranged
from 7 to 359,000 vital particles/mm3. All patients were on stable anti-retroviral combination therapies. Body pictures and anthropometric measurements are
taken at baseline and at the end of the study. Biolectric Impedance Analysis (BIA)
and A quality of life (QOL) questionnaire were provided at baseline, week 6, week
12, and a follow up at week 20. The duration of the study was four months.
Results: The average percent increase in total weight for this patient group
was 11.3 Lbs. (9.27%). The largest weight percent increase was 16.55% and the
lowest was 3.05%. The average BCM percent increase was 8.6 Lbs. (13.75%).
CD8 counts increased 65.68% and CD4 count increased an average of 19.94%.
Albumin, a good marker wasting syndrome which has been correlated to survival,
increased an average of 9.21%. Viral loads and liver function tests were not
adversely affected by the program. Quality of life improved dramatically in all
patients.
Conclusions: This comprehensive program which includes nutrition, supplementation, resistance exercise and anabolic steroid therapy effectively increased
total body weight and body cell mass in this patient population. Albumin, CD8
and CD4 counts increased in 78% of patients. No adverse effects were observed.
Quality of life was enhanced. Because of these encouraging results, a placebo
controlled, double blinded, randomized study of this program is recommended.
32186 Evaluation of serial observations of weight and body
composition changes in HIV+ patients
Cade Fields-Gardner, K. Jennings. PO Box 922 Cary, 11.60013; Nutricare,
United States
Background: Recently reported data suggests that indicators of malnutrition and
clinical wasting may persist beyond the successful reduction of viral load and
improvement in CD4 counts. This investigation was conducted to determine the
relationships between markers of disease progression and weight or body composition changes. Information regarding treatment with highly active antiretroviral
therapies and anabolic treatments were included in the evaluation.
Methods: An observational database compiled profiles of more than 350 patients (pts) at 8 sites over a period of 3 months to 2 years. Data were collected on
weight (wt), usual weight, body composition (body cell mass, extracellular mass,
and fat mass via bioelectrical impedance), medical history, medication profile,
symptoms, nutritional interventions, and laboratory values (eg, CD4, HIV RNA,
testosterone, albumin, cholesterol, triglycerides). An analysis of a subgroup of
28 patients with serial data from a single medical practice presented here is

evaluated for frequencies and correlation.
Results: A variety of profiles were seen among the 28 patients evaluated. Initial
wts in 16/28 were less than calculated ideal body weight and 7/28 weighed less
than a reported usual body wt. 16/28 gained wt, 1/28 maintained wt, and 11/28 lost
wt during the observation period which ranged from 3 to 24 months. Wt change
ranged from -19.1 kg to +8.2 kg. The average wt gained was 2.65 kg and the