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

12th World AIDS Conference

Abstracts 42254-42339 841

42335 The effects of oxandrolone (OX) plus resistance exercise
(RE) on Unitrogen Balance (N BAL), body composition
and strength in men with AIDS wasting syndrome (AWS)
Alison Strawford, T. Barbieri2, M. Van Loan2, E.J. Parks3, J. King2, N. Barton4,
M.K. Hellerstein2. Nutritional Sciences, Morgan Hall, UC Berkeley, Berkeley, CA
94720; 2 Western Human Nutrition Research Center, San Francisco, CA;
3Nutritional Sciences, UC Berkeley Berkeley, CA; 4 Biotechnology General
Corp., New Jersey NJ, USA
Background: LBM loss is related to time of death in HIV/AIDS and restoration of
LBM may improve survival.
Methods: We compared OX (20 mg/day) plus RE to placebo (P) plus RE in
men with AWS (n = 23, 92 ~ 3% usual weight, age 41 + 8 yrs, serum total
testosterone (T) 556 ~ 298 ng/dL mean ~ S.D) in an 8 wk placebo-controlled randomized study. To assure uniform T levels during the study, all subjects received
T at replacement doses (100 mg IM/wk). 13/23 subjects were receiving protease
inhibitors (weight stable >3 months). 10-day in-patient N Bal studies were performed at baseline and after 4 weeks of treatment. Controlled RE was carried out
3 times/wk under supervision. Follow up measurements of body composition by
DEXA, strength by 1-repetition max (1 RM) and dynamometer were carried out
at 8 wks.
Results: (1) N retention increased significantly from baseline in both groups
(+3.8 ~ 1.8 g/day P/RE, +5.6 ~ 2.1 g/day OX/RE, p < 0.05 between groups)
representing a gain of 0.9 ~ 0.4 Kg LBM/wk for P/RE and 1.3 ~ 0.5 Kg/wk for
OX/RE. (2) Weight and LBM increased significantly from baseline in both groups
(weight 4.2 ~ 2.8 Kg, LBM 3.8 + 2.9 Kg (P/RE group); weight 6.7 ~ 2.0 Kg, LBM
6.9 1 1.7 Kg (OX/RE group); p < 0.05 vs baseline and between groups (see
figure). (3) Strength improved in both groups (1 RM chest press 18 ~ 8% vs 34
~ 6%, leg press 28: 4% vs 38 ~ 8%, in P/RE and OX/RE groups respectively,
data mean ~ S.E.). Strength by dynamometry also improved and was significantly
greater in OX/RE than P/RE (see figure). (4) Viral load (baseline 45,900 ~ 27,500,
mean ~ S.E.) did not change significantly. (5) LBM gain continued over the 12
weeks of open-label therapy (1.0 4 2.5 Kg LBM for whole group).: IjP/RI
0 OX/iRl

42337 Zinc deficiency profoundly increases risk for HIV-1
related mortality
Marianna Baum, G. Shor-Posner, S. Lai, H. Lai, E. Perez, J.B. Page. University
of Miami, Room 1006, 1400 NW 10th Ave, Miami, FL, USA
Objective: Zinc is thought to promote activity of the HIV-1 virus. This trace element is, however, essential for maintaining a healthy immune system. As zinc
deficiency is prevalent in HIV/AIDS, the aim of this study was to evaluate zinc
status, disease progression and HIV-1 related mortality
Design: A longitudinal study was conducted over 3.5 years in 118 HIV-1
seropositive men and women who abuse drugs.
Methods: Zinc intake was examined in relation to plasma zinc levels, CD4 cell
count and HIV-related mortality. A multivariate Cox model, adjusted for age, sex,
race and CD4 cell count over time was used to analyze the longitudinal data.
Results: Eighty-six percent of the HIV-1 infected drug users consumed dietary
intake below the recommended dietary allowance and 56% of the group had
plasma zinc levels considered deficient (<0.75 t<g/ml). Plasma zinc levels were
positively associated (p = 0.005) with CD4 cell count, and overtly low plasma zinc
was associated (p = 0.002) with advanced disease (CD4 <200 cells/mm3). While
plasma zinc has been previously described as a marker of disease progression,
those with higher intake of zinc over time, exhibited significantly higher levels of
plasma zinc (p < 0.0001). In addition, low dietary zinc intake (below the median
of 9.34 mg/day) was significantly associated with a dramatic risk for mortality (RH
= 36.97, p < 0.03).
Conclusions: The significant association between dietary and plasma zinc,
and poor survival in HIV-1 infection indicates that adequate amounts of dietary
zinc are needed to slow disease progression. Zinc therapy in HIV+ individuals
who have overtly low plasma zinc levels needs to be investigated.
42338 Nutritional status and health-related quality of life in
patients infected with HIV
Lawrence Kim, M. Keiserman, J. Maimares Schmidt, J. Tuveson, J. Koch. Univ.
Calif San Francisco, 1001 Potrero Avenue 3D, San Francisco, CA 94110, USA
Background: Weight loss is an independent predictor of mortality among patients
infected with HIV. However, whether overall weight loss or specific loss of fat
mass or body cell mass impact individual dimensions of health-related quality of
life (QOL) has not been studied.
Methods: All patients referred for evaluation to the Gastroenterology-HIV-Nutrition clinic were asked to complete the Rand SF-36 Health Survey questionnaire
(a standardized QOL measurement). Body weight and height were measured.
Bioelectrical impedance analysis (BIA) was performed to determine fat mass
(%FAT) and body cell mass (%BCM) as a percentage of total body mass.
Results: 69 patients completed questionnaires and BIA measurements (65
male, mean age 39, median CD4 cell count 166/mm3). In univariate analyses,
%BCM was associated with QOL subscales pertaining to physical functioning
and general health. In contrast, no significant associations were found between
weight as percentage of usual body weight (%UBW) or %FAT and any subscales.
No association was seen for %BCM and QOL subscales pertaining to emotional
well-being, energy, and social functioning.

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Conclusions: Both OX/RE and P/RE resulted in a robust anabolic effect,
without adverse side effects or increases in VL. OX/RE showed a significantly
greater improvement in nitrogen retention, LBM accrual and strength than the
P/RE group. Studies of other treatment combinations and earlier intervention prior
to the onset of AWS will be of interest.
42336 Glutamine/antioxidant supplementation promotes gain in
body cell mass in HIV patients with weight loss
Judith Shabert1, Charmaine Winslow2, J.K. Shabert', J. Lacey3, D.W. Wilmore1.
1Brigham And Women's Hospital 75 Francis Street, Boston, MA; 2Nutrition
Specialty Center, Bocaraton, FL; 3Simmons College, Boston, Ma, USA
Loss of body cell mass (BCM), the active functioning tissue of the body, commonly
occurs in patients with HIV infection; the extent of wasting is related to the length
of survival. In order to evaluate the role of the amino acid L-glutamine (GLN) and
antioxidants on AIDS-associated wasting, we studied 26 individuals with weight
loss _-10% of ideal. Subjects were randomized to receive GLN/antioxidants 40
g/d (Cambridge Nutraceuticals, Boston, MA) in divided doses or glycine (40 g/d)
as placebo for 12 weeks. Throughout the study, the subjects were seen weekly by
a nutritionist and bioelectrical impedance analysis, [(BIA), RJL Systems, Clinton
MI)], body weight and nutrition counseling were performed.
Twenty one subjects (average age 39 yr, 19 M, 2 F) completed the study.
Five patients were excluded for the following: death (1 control), major change
in antiretroviral drugs (1 control), terminated for personal reasons (2 control, 1
GLN). The values for the two groups are shown below (mean ~ SD)

SF36 Subscale
Physical Functioning
Role Limits due to Physical Health
General Health

% UBW
Coeff p
13.5 0.60
21.0 0.53
24.7 0.20

% FAT
Coeff p
0.27 0.53
0.15 0.80
0.14 0.65

% BCM
Coeff p
0.90 0.003
0.79 0.05
0.47 0.03

Control
pre post
Weight (kg) 71.6 + 11.2 71.9+ 11.2
Body cell mass (kg) 28.4 i 6.0 28.8 1 6.1
Total body water (1) 43.3 ~ 8.0 43.5 ~ 7.8
Intracellular water (1) 25.9 i 5.4 26.5 1 5.4
Extracellular water (1) 17.3 4 2.9 17.0 + 2.8
P. 0.002 and P - 0.02

GLN/Antioxidant
pre post
68.3 + 8.3 70.6 1 8.9
26.9 4 4.5 28.6 ~ 4.6
42.3 ~ 5.0 43.8 + 5.7*
25.6 ~ 4.7 27.3 ~ 5.0"
16.7 1.3 16.4 ~ 1.8

All significant univariate associations between %BCM and QOL subscales
remained significant after adjustment for age, sex, and CD4 count. The association between %BCM and QOL subscales was also independent of %FAT in
multivariate analysis (p < 0.10).
Conclusion: Physical aspects of health-related quality of life among patients
with HIV are strongly associated with percentage body cell mass. In contrast,
body weight and estimates of fat percentage do not predict quality of life. Body
composition analysis is a better indicator of functional status in patients with HIV
than body weight. Interventions that improve body cell mass should be assessed
for corresponding improvements in physical function and quality of life.
142339 Protein intake is associated with body cell mass in
weight-stable HIV+ men with CD4 < 200 cells/mm3:
CPCRA 038
S. Bruce Williams', G. Collins2, N. Muurahainen3, G. Bartsch2, C. Gibert4,
S.S. Raghavan5, D. Wheeler6. Comm. Prog. for Clin. Research on AIDS, 12211
Lomas Blvd. NE; Albuquerque, NM; 2Minneapolis, MN; 3Philadelphia, PA,
4 Washington, DC; 5New York, NY; 6Annandale, VA, USA
Objective: To determine the associations of body cell mass (BCM), total body
fat (TBF), and extracellular mass (ECM) with macronutrient intake among HIV+
men in the United States with CD4 count <200 cells/mm3 and documented stable
weight.
Methods: Measurements of BCM, TBF, and ECM by bioelectrical impedance
analysis and macronutrient intake by 24 hour food recall were made at baseline

GLN/antioxidant nutrient supplement can increase body weight, body cell mass
and intracellular water when compared to placebo controls. The specific tissues
which account for the increase in BCM by GLN/antioxidant supplementation have
yet to be defined but this approach provides a highly cost-effective therapy for
the rehabilitation of HIV patients with weight loss.