Malnutrition is common in human immunodeficiency virus (
HIV) infection and plays an important role in morbidity and mortality.
Malnutrition can affect hospitalizations, disease complications, quality of life, and survival, and has adverse clinical consequences that may be independent of CD4 lymphocyte count. There have been recent advances in knowledge concerning the pathogenesis of
malnutrition and the nature of
weight loss in HIV patients. The onset of body cell mass depletion may occur early in the
infection and
predate significant immune deficiency, implying that the virus itself may be involved.
Hypogonadism, a common finding in HIV patients, is associated with body composition changes and is involved in body cell mass depletion. In addition, intestinal dysfunction and malabsorption contribute to
weight loss in HIV patients. Several studies have evaluated the use of
appetite stimulants, enteral and parenteral
nutritional support,
anabolic agents, and other agents in the management of
weight loss and
malnutrition in HIV patients. Results of a randomized trial comparing
total parenteral nutrition (TPN) and an oral semi-elemental diet (SED) in
AIDS patients with malabsorption indicate that the TPN group consumed more calories and gained more weight than the SED group, but the gain was due to increased body fat. The effect of
nutritional support on
malnutrition and
weight loss in HIV patients and potential secondary benefits to quality of life, physical and mental performance, immune function, and
disease progression require further study.