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

844 Abstracts 42254-42353

12th World AIDS Conference

of diet, and questions about empowerment and control may be most important in
predicting dietary quality. Patients feeling the least positive or the least in control
may be the ones who most need dietary intervention and counseling.
S42349 Expanded nutritional evaluation in patients with HIV
infection
Waldo H. Belloso1 2, M. Perman2, L. Barcan2, C. Kecskes2, F. Goldin2,
E. Menendez2, L. Clara2. 1'Av. F. Lacroze 2045 2B, 1426 Buenos Aires; 2Hospital
Italiano De Buenos Aires, Argentina
Body Cell Mass (BCM), albumin, and Percentage of Usual Weight (PUW) were
recognized as predictors of mortality in patients with HIV infection. Other related nutritional and metabolic determinations might be more sensitive to detect
metabolic disturbances, although they are not usually included in routine assessment.
Objective: Analyze nutritional status and the additional information provided
by an expanded nutritional evaluation (ENE) in routine first visit of HIV patients
and evaluate its correlation with immunological status.
Methods: Prospective evaluation of an HIV patients cohort (first visit). Determination of Percentage of Ideal Weight (PIW), PUW, Body Mass Index (BMI),
Anthropometric measurements, Albumin, Creatinin/Height Index (CHI), Total Urinary Nitrogen (TUN), Measured (calorimetry) vs. Predicted (Harris Benedict)
Resting Energy Expenditure (REE), and Body Composition by bioimpedance
-with Body Cell Mass (BCM).
Results: A total of 46 patients were evaluated (36 male) with a mean age of
41.7 years and a median CD4+ count of 143 cells/mm3 (r 2-981). Mean PUW
was 96.9% ~ 12.3 and mean BMI was 23.7 ~ 4.2. A total of 9/46 patients
had evidence of malnutrition as by PUW, PIW or BMI. Mean albumin was 4.08
~ 0.5 g/dl and none of the patients had <3 g/dl. Median CHI was 91.57% (r
43.9-148); median TUN was 12.4 g/24 hs (r 4.3-24) and 12/34 patients had just
this abnormal parameter on screening. Median BCM was 35% (r 16.9-42) and
10/35 patients had an altered BCM in abscence of other evidence of malnutrition.
Median REE rate was ~ 13% (r - 7 -+ 50) and 4/25 patients showed moderate
hypermetabolism as the only altered finding. ENE disclosed normal findings in
7/46 patients. Correlation between CD4+ count and all ENE parameters were r <
0.5, and also weak correlations were found betwen PUW and BCM (r 0.14) and
REE (r 0.01) respectively.
Conclusions: 1) Our HIV population appears to be relatively well nourished.
2) Metabolic and nutritional alterations, with potential prognostic and therapeutic
consequences, were commonly found by ENE. 3) These alterations could not
have been predicted by the usual nutritional evaluation.
42350 Nutrition as complementary therapy among minority and
disadvantaged
Marie Saint CYR, Rosa J. Donohue, MS, RD, CDN. Iris House 2271 Second
Avenue New York, New York USA, USA
Issue: Malnutrition continues to be a major contributing factor in progression
of disease from HIV infection to AIDS, particularly among low-income minority
groups with limited access to food and to drug therapies. Comprehensive nutrition
intervention can help to slow down or delay this progression of disease.
Project: A community-based organization serving low-income minority women
infected by HIV developed a program to improve the nutritional status of this population. Comprehensive client service included a nutritional assessment, individual
nutrition counseling and follow-ups, weight gain group sessions, hands on nutrition work shops, pantry food packages, cooking classes, congregate meals and
case management support. Registered dietitians ran the program. The emphasis
was on empowering clients to make better food choices in order to address their
particular needs like weight loss, nausea, diarrhea, food-medication interaction,
nutrient deficiencies, etc. This exclusively food-oriented approach, provided in a
caring and respectful environment, encouraged selection, preparation and consumption of nutrient-dense and calorie-dense foods according to the individual
needs.
Results: Participation in the Nutrition Program surpassed the expectations,
particularly in the cooking classes and the weight gain group. Over 60% of under-weight clients at risk of wasting have been able to gain weight and maintain
it.
A large percentage of clients made positive eating behavior changes and most
reported improvement in their quality of life after a few months on the program.
Lessons Learned: Community based organizations with limited resources can
improve the nutritional status and quality of life of low-income minority people with
HIV/AIDS through comprehensive food-oriented, hands-on experience nutrition
interventions that are also sensitive to the cultural diversity of the population
served and are made available in the early stages of the disease.
42351 The effects of oxandrolone on body weight and
composition in patients with HIV-associated weight loss

Alvan Fisher1, M. Abbatilola2. 1Brown Univ and Oxandrin Study Group,
400 Reservoir Avenue, Providence, RI 02907; 2Coastal Medical, Providence, RI,
USA
Background: Longitudinal changes in body weight and composition in patients
with HIV-associated weight loss treated with an oral anabolic agent (oxandrolone)
for a maximum of 12 months are being examined in an open-label, commu
nity-based trial. Enrollment of patients will continue until a database suitable
for multivariate analysis is achieved, so that clinical features associated with
differences in response to anabolic therapy can be identified.
Methods: HIV+ patients with documented weight loss, free of acute opportunistic infection or rapidly progressive cancer and on stable antiretroviral regimens
are offered open-label oxandrolone 20 mg daily. Body weight and composition,
determined by bioelectric impedance analysis (BIA), are assessed at baseline
and following 1, 2, 4, 8 and 12 months of treatment.
Results: 572 patients (527M/45F) are currently enrolled in the trial. Complete
longitudinal body weight data are available on 26 patients treated continuously for
12 months at eight clinical sites. Mean increases in body weight of 1.9, 1.7, 4.3,
5.2 and 5.2 kg were observed at 1, 2, 4, 8 and 12 months, respectively (p < 0.01
at each time point relative to baseline). BIA revealed significant increases in body
cell mass at all time points (0.9, 1.4, 2.2, 3.1 and 3.5 kg) with significant increases
in intracellular water content at 2, 4, 8 and 12 months (p < 0.05). Oxandrolone
was well tolerated with minimum side effects and enhanced quality of life.
Conclusion: Oxandrolone reverses the abnormalities of body composition
characteristic of HIV-associated weight loss and is well tolerated during prolonged courses of treatment.
42352 Biochemical measurements of specific B-group vitamins
in a cohort of HIV positive and negative injection drug
users
Alice Tang1, E. Smit1, N. Shah1, D. Li1, D. Vlahov1, N.M.H. Graham2. 1Johns
Hopkins University, 615 N. Wolfe St., Baltimore, MD; 2Glaxo-Wellcome Inc.,
Research Triangle, NC, USA
Objectives: To determine the serum levels of specific nutrients in participants of
a US inner-city cohort of male and female injecting drug users (IDUs), with and
without HIV infection.
Design: Cross-sectional analysis on a subsample of a longitudinal cohort study.
Methods: The study population consisted of 186 HIV+ and 213 HIV-IDUs.
Dietary intake was assessed using a 24-hour recall administered by a trained
interviewer. Biochemical measurements included serum levels of vitamins B12
and folate, and red cell folate. Means and medians were compared between
HIV+'s and HIV-'s using t-tests and Wilcoxon rank-sum tests. Comparisons were
also made between three categories of CD4+ cell count (<200 cells/pll, 200-499
cells/Il, >500 cells/pl) in the HIV+'s.
Results: Serum B12 levels were unexpectedly higher among HIV+'s compared
to HIV-'s. Among the HIV+'s, serum B12 levels tended to increase with decreasing CD4 levels. Both serum folate (p = 0.0001) and red cell folate (p = 0.0003)
were significantly higher in HIV+'s compared to HIV-'s. However, mean and
median serum B12 and folate levels were in the normal range for both HIV+'s
and HIV-'s. Dietary intakes of vitamin B12 did not differ by HIV status, however
folate intakes were somewhat higher in HIV+'s compared to HIV-'s. A higher
proportion of HIV+'s compared to HIV-'s reported no alcohol consumption (47%
vs 31%, p = 0.002) and no cigarette smoking (17% vs 10%, p = 0.06) in the prior
6 months. Average self-reported injection drug use in the previous 6 months was
significantly lower in HIV+'s compared to HIV-'s (97 vs 167 injections over 6
months).
Conclusions: In contrast to other populations, our population showed higher
serum B12 and folate levels among HIV+'s compared to HIV-'s. This may be partially explained by a higher proportion of non-drinkers and non-smokers among
the HIV+'s. Analysis is ongoing to examine differences in vitamin supplement
use and lifestyle changes in HIV+ vs. HIV- IDU's. These results are particularly
encouraging given that this is a population which is traditionally less likely to have
access to health care and highly active antiretroviral therapy.
42353 Taste and smell dysfunction in HIV infection
Alison E. Heald, C.F. Pieper, S.S. Schiffman. Box 3284 Duke University Medical
Center, Durham, NC 27710, USA
Objectives: (1) To define the scope of taste and smell (chemosensory) complaints
among HIV-infected persons attending the Duke Infectious Diseases (ID) Clinic.
(2) To evaluate the clinical factors associated with chemosensory complaints. (3)
To determine the impact of chemosensory complaints on quality of life.
Design: Cross-sectional survey
Methods: Between 2/97 and 5/97, 207 patients attending the Duke ID Clinic
were surveyed. Patients completed a taste and smell questionnaire, and a quality
of life questionnaire (MOS-HIV) and underwent a brief interview and chart review.
Results: A majority of patients (70%) reported chemosensory complaints; 91
(44%) reported both taste and smell complaints; 47 (23%) reported only taste
complaints; and 6 (3%) reported only smell complaints. Many patients complained
that drugs interfered with their sense of taste, or that medications tasted bad. The
number of medications taken, tobacco use, and hay fever were the best predictors
of the chemosensory complaint score using multiple regression analysis. Patients
with chemosensory complaints had significantly lower scores in all domains of the
MOS-HIV than those without complaints. Quality of life, as measured by mental

and physical health summary scores, was significantly lower in patients with
chemosensory complaints even after controlling for number of AIDS diagnoses,
number of medications, CD4 cell count, and HIV-1 viral load.
Conclusions: Chemosensory complaints were common in the patient population and were associated with a poor quality of life after adjustment for stage of
disease, number of medications, CD4 cell count and HIV-1 viral load. Medications
played an important role in chemosensory complaints. Measures to optimize taste