Nutritional disorders in HIV disease.

Reviewing the medical literature since 1981 show that patients with acquired immunodeficiency syndrome (AIDS) usually suffer from poor ingestion and absorption, increased excretion of nutrients, metabolic and endocrine abnormalities and immunologic abnormalities which impair nutrition. Human immunodeficiency virus (HIV) and associated opportunistic infections stimulate a broad and complex array of responses which include fever, hypermetabolism, leukocytosis, proteolysis of skeletal muscle, and synthesis, by the liver, of acute-phase reactant proteins and various intracellular enzymes. These responses increase gluconeogenesis and lipogenesis, decrease albumin synthesis, and redistribute and/or sequester various trace elements. Infection-induced depletion of body nutrients serves to weaken host resistance. The deterioration of the nutritional status of these patients is likely to have an important effect on the course of the disease. It is thus evident that comprehensive management of HIV infection must include nutritional evaluation and treatment. When oral nutrition proves to be insufficient to maintain adequate intake, alternative routes must be considered. Selection of an appropriate nutritional support formula requires an evaluation of the absorptive capacity of the gastrointestinal (GI) tract, the length of time required for nutritional repletion, costs, patient acceptance, and feasibility of at-home use. Nutritional support maximizes the ability of the AIDS patient to resist infection, may favor the response to medication by decreasing the incidence of adverse drug reactions, and may prolong the quality and productivity of life.