Macallan D C
Department of Medicine and Cellular & Molecular Sciences, Division of Infectious Diseases, St. George's Hospital Medical School, London SW17 ORE, United Kingdom.
J Nutr. 1999 Jan;129(1S Suppl):238S-242S. doi: 10.1093/jn/129.1.238S.
AIDS wasting is not characterized by a single pathophysiological process but by a variety of processes that operate at different times. Acute wasting tends to be associated with secondary infections; chronic wasting is associated with gastrointestinal disease. Although resting energy expenditure is increased, total energy expenditure is reduced in individuals who are losing weight and it is usually reduced intake that commonly drives wasting. However, reduced intake is not an adequate explanation for the metabolic abnormalities that are seen in HIV infection. In particular, protein metabolism and lipid metabolism are abnormal, possibly representing inappropriate utilization of substrates. The response to nutrition may be impaired, particularly in terms of accrual of lean tissue but nutritional support may prolong survival. The impact of protease inhibitors on wasting in HIV infection is yet to be fully ascertained but despite antiviral therapy it seems that wasting is likely to remain a problem at least in some patients.
艾滋病消瘦并非由单一的病理生理过程所致，而是由不同时期发生作用的多种过程引起。急性消瘦往往与继发感染有关；慢性消瘦则与胃肠道疾病相关。尽管静息能量消耗增加，但体重减轻者的总能量消耗却减少，通常是摄入量减少导致消瘦。然而，摄入量减少并不能充分解释在HIV感染中所见到的代谢异常。特别是蛋白质代谢和脂质代谢异常，可能代表底物利用不当。对营养的反应可能受损，尤其是在瘦组织积累方面，但营养支持可能会延长生存期。蛋白酶抑制剂对HIV感染患者消瘦的影响尚未完全明确，但尽管进行了抗病毒治疗，消瘦似乎至少在一些患者中仍将是一个问题。
