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

12th World AIDS Conference

Abstracts 42254-42358 845

and smell function may improve quality of life and prevent complications such as
inadequate oral intake, malnutrition, weight loss, and ultimately wasting.
42354 Association of body composition, measured bioelectrical
impedance analysis (BIA), nutritional state, and HIV
status among HIV-infected men
Neil Ampel1, J.M. Bowers2. 1VAMC (111) 3601 S. Sixth Avenue, Tucson AZ;
2Tucson VAMC, Tucson, AZ, USA
Objectives: Determine the relationship between BIA-measured body composition, nutritional status, and HIV infection.
Design: Prospective cross-sectional study of male HIV-infected patients enrolled in a Veterans Affairs HIV primary-care clinic.
Methods: Bioelectrical resistance and reactance were determined by applying
a single-frequency current with an RJL impedance plethysmograph and phase
angle (a), body cell mass (BCM), and extracellular mass (ECM) were calculated.
HIV-related laboratory data analyzed included plasma HIV RNA and CD4//r obtained within 1 month of BIA. HIV was uncontrolled if HIV RNA > 5000 and CD4
S200//1. Clinical AIDS was defined as an AIDS-defining opportunistic process
exclusive of CD4 count. Nutritional assessment included serum albumin (alb),
prealbumin (prealb), testosterone (test), and basal metabolism by Harris-Benedict
equation (HBE). All subjects were clinically stable and not hospitalized.
Results: 60 men were studied. Mean ~ SEM age (yrs): 46 + 1; weight (kg):
74.7 ~ 2.0; CD4//1I: 367 ~ 33; loglo HIV RNA (copies/ml): 3.12 ~ 0.25; phase
angle a: 6.4 0.1, BCM 29.7 ~ 6; ECM/BCM: 1.12 + 0.02; alb: 4.1 ~ 0.1; prealb
27.6 + 1.7; test 498 ~ 54; and HBE (kcals) 1664 ~ 33. BCM and ECM/BCM
were both significantly associated with a (r2 =.46,.85; for both p <.0001); a was
also significantly associated with alb (r2 =.30, p -.0001), prealb (r2 =.36, p =.007), test (r2 =.30, p =.003), and HBE (r2 =.26, p <.0001). However, a was not
associated with CD4 (r2 =.04, p =.11) or HIV RNA (r2 =.0002, p =.91). There
were also no significant differences in a between uncontrolled vs controlled HIV
infection (6.25 vs 6.39, p =.633) nor between subjects with clinical AIDS and
those without (6.08 vs 6.51, p =.087).
Conclusions: Phase angle (a) measured by BIA has been previously associated with mortality in HIV-infected subjects. These data show that it is also closely
associated with other measures of nutritional status but not with immunologic,
virologic, or clinical HIV status.
42355 The potential impact of oral liquid nutritional
supplements on oropharyngeal candidiasis in
HIV-infected patients - A retrospective analysis
Diana Peabody, David Burdge, W.S. Fairley. Oak Tree Clinic and The University
of British Columbia, Oak Tree B4, 4500 Oak Street, Vancouver, British Columbia
V6H 3N1, Canada
Background: HIV positive people may be hesitant to use liquid nutritional supplements (LNS) containing high amounts of simple sugars because of concern about
oropharyngeal candida infection (OCI) which could adversely affect nutritional
status. This study was designed to assess the impact of LNS on the incidence
and severity of OCI in our HIV centre.
Methods: A retrospective review of clinical records for all patients >18 years,
followed -3 mos prior to LNS, and who took LNS for >3 mos between February 94
and August 97 was performed. The presence and severity of physician diagnosed
OCI during the 3 mos prior and initial 3 mos of LNS was documented with details
of LNS use, CD4 cell counts, viral load, antibiotic use, antiretroviral therapy (ART),
injection drug use (IDU) and the use of topical and systemic antifungals. All LNS
were prescribed by the clinic physician after nutrition consultation. Descriptive
statistical analysis was performed.
Results: 37 pts met study inclusion criteria; 23 (62%) female, 14 (38%) male;
25 (65%) had history of IDU. CD4 counts were: -500, 4 (11%); 200-500, 18
(48.6%); _-200, 15 (40.6%). A total of 9 (24%) pts had documented OCI; 3 had
OCI prior to LNS use which continued during LNS use, 3 initially had OCI which
resolved during LNS use, and 3 developed OCI after LNS use began. 5/6 pts with
OCI prior to initiating LNS and 2/3 pts that developed OCI on LNS had CD4 <100.
5 pts used topical antifungals prior to LNS, 8 during LNS; 6 pts used systemic
antifungal prior to LNS, 5 during LNS. 17 pts received systemic antibiotics during
the 3 months before LNS, and 15 during LNS. All patients received either Ensure,
Ensure Plus or Boost.
Conclusions: In 37 HIV positive patients given at least 3 mos of liquid nutritional supplements, no differences were observed in the rate or severity of
oropharyngeal candidiasis before versus during LNS. Rates of topical and systemic antifungal use were also similar. Further prospective study of the impact of
LNS on superficial fungal infection is needed, but we continue to recommend and
prescribe LNS to nutritionally deplete patients; the nutritional benefit far outweighs
any potential risk of oral candidiasis.

42356 Teaching paraprofessionals the basics of nutrition and
HIV within a harm reduction paradigm
Diane Babicz. NJAETC at UMDNJ 30 Bergen St ADMC 710, Newark NJ
07107-3000, USA
Issue: Adequate nutrition is a foundation for success of medical therapies and a
key component in enhancing a client's quality of life. Unfortunately many PLWH/A
do not access nutritional care as a means to preventing opportunistic infections

and maintaining health, but as a means to reversing the damaging consequences
of wasting syndrome in later stages of HIV disease. Community-based frontline
workers, often a PLWH/A's first contact upon entry into medical care, can be
a source for disseminating basic nutrition information and conducting simple
nutrition assessment to identify clients at nutritional risk.
Project: A 6 hour course provided to self-selected case managers and drug
treatment counselors increased general understanding and awareness of nutrition
as an essential preventive and therapeutic cotherapy for the management of HIV
disease, as measured by a pre/post test design. Topics included balanced eating
for building/maintaining muscle mass, designing ethnically appropriate menus and
modifying them to alleviate symptoms of diarrhea/nausea/vomiting/oral thrush,
water/food safety guidelines, food choices on a limited budget. ProchaskaDiClemente's Stages of Change model was taught as a strategy to encouraging
small improvements toward healthy eating. Community resources for free food
assistance, educational tools for low literacy clients, and referrals to HIV Nutrition
Specialists were provided.
Lessons Learned: Program evaluations indicated renewed interest in nutrition
as a cotherapy in HIV care. Nutrition is now increasingly selected as a topic for
on-site training requests at CBOs. Training paraprofessionals can provide greater
outlet for nutrition information dissemination, education, and referral to an HIV
Nutrition Specialist.
42357 Feasibility of increasing lean body mass in HIV-infected
adults using progressive resistance training
Ronenn Roubenoff, Ann McDermott, Michael Wood, Juliet Suri. Human Nutrition
Res. Ctr, Tufts University 711 Washington Street, #1313, Boston, MA 02111,
USA
Objective: Wasting is a major cause of disability and mortality in HIV infection.
Pharmacologic treatments for wasting are expensive and have potentially severe
side effects, and prevention of wasting is not well understood. We examined the
capacity of progressive resistance training (PRT) to increase lean body mass
(LBM) in adults with HIV infection.
Design: Clinical trial with control observation period.
Methods: Nineteen adults with HIV infection participating in the Tufts Nutrition
for Life Study (15 M, 4 F; 9 African-American, 9 Caucasian, 1 Native-American;
mean age 41, range 32-47; mean CD4 count 202 mm sup 3, mean viral load 4.1
x 105, mean BMI 24.6 kg/m sup 2; risk factors for HIV: IVDU 9, MSM 9, Unknown
1) completed 8 weeks of PRT using compressed air resistance equipment (Keiser
Co., Fresno, CA). Subjects trained three times per week at 80% of 1-repetition
maximum, performing 3 sets of 8 repetitions/machine. Body composition was
measured by dual-energy x-ray absorptiometry (DXA; Hologic QDR 2000).
Results: After 8 weeks of PRT, mean strength (summed over leg extension,
leg press, chest press, and lateral pull) increased by (mean ~ SD) 50.7 ~ 12.1%.
There was an increase in body weight of 1.1 ~ 2.6 kg (p - 0.07). LBM increased
by 2.1 ~ 1.8 kg (p - 0.0001), while body fat declined by 0.9 & 2.5 kg (p < 0. 12).
After a subsequent 8-week period of usual activity, much of the gain in strength
and LBM was still present. Supported by NIH Grants DK45734 and RR00054
Conclusion: These data indicate that LBM can be increased in HIV(+) adults
using a short-term, high-intensity PRT program.
42358 Providing access to HIV-research opportunities for
disenfranchised populations
Michael Kaiser1, Judith Hagopian1, Johnson Ernestine3, Jack Moye2
Mary Fowler3, Carol Nesel4. 1HRSA, Rm 18A 19, 5600 Fishers Lane, Rockville,
Maryland;4 WESTAT Rockville, Maryland, MD; 2Mofens On Lynne, NIH NICHD;
3 NIH NIAID, Bethesda, MD, USA
Issue: Low income individuals and families of color around the world have historically been under-represented in clinical research studies. In the United States, it
is a national priority to expand research of potential clinical benefit to HIV-infected
children, youth and women.
Project: The Title IV program of the Ryan White CARE Act provides access
to care for infants, children, youth and women infected with HIV. In 1996, the
CARE Act was amended to require that Title IV clients have access to research
of potential clinical benefit and that the Health Resources and Services Administration and the National Institutes of Health (NIH) develop a plan to coordinate
efforts. The NIH-supported Pediatric AIDS Clinical Trials Group (PACTG), a nationwide network of AIDS research sites, is funded to evaluate treatments for
HIV-infected children and adolescents and develop new approaches for the interruption of mother-to-infant transmission. Through a collaborative effort between
the National Institute of Child Health and Human Development (NICHD) and
the National Institute of Allergies and Infectious Diseases (NIAID), NIH invited
Title IV non-PACTG sites to participate in ACTG Protocol 247, "A Randomized
Double-Blind, Controlled Study of an Increased Caloric Density Infant Formula
and Its Effect on Growth and Nutritional Status to HIV to HIV-Infected Infants."
NIH is supporting the cost of patient visits to non-PACTG sites.
Results: Eight Title IV non-PACTG sites were selected to participate in this

study. This project will for the first time directly enroll clients at Title IV non-PACTG
sites in an NIH clinical trial. This study gives unique access to PACTG investigational treatment trials to families who otherwise would not have had access, and
benefits the PACTG by increasing enrollment in an important study.
Conclusion: Since women and infants at Title IV sites are just beginning to
be enrolled, it is premature to draw any conclusions. However, if successful, this
collaborative effort could serve as a model to increase research opportunities for