Macronutrient intake and malabsorption in HIV infection: acomparison with other malabsorptive states

Background—Wasting is a major complication of HIVinfection. The role of malabsorption in wasting is controversial.
Aims—To assess oral intake and malabsorption in acohort of weight losing HIV infected patients, with or without chronic diarrhoea.
Methods—A prospective study using a predefinedprotocol for HIV infected patients was performed in a gastroenterologyand nutrition unit in a university hospital. A retrospective comparison was made with HIV negative patients with malabsorption due either tosmall bowel disease or resection. Body weight and height, serum albumin, oral intake of macronutrients, faecal weight, and faecal fatwere measured.
Results—Seventy nine weight losing HIV infectedpatients were studied. Among the 66 patients with more than 5% lipidmalabsorption, wasting was significantly greater in patients withcryptosporidiosis (n=22) than in patients with microsporidiosis (n=18)who exhibited significantly more wasting than patients with noidentified enteropathogen (n=26) (body mass index 16.8 (14.0-20.7),18.9 (16.5-21.3), 19.7(15.9-23), respectively). When controlling forthe level of lipid malabsorption, HIV infected patients had asignificantly lower energy intake than HIV negative patients withchronic malabsorption. In HIV infected patients, but not in othercategories of malabsorbers, body mass index correlated significantlywith energy intake (r=0.33, 95% confidence intervals 0.12 to 0.51).
Conclusion—In weight losing HIV infectedpatients, reduced energy intake is superimposed on malabsorption andsignificantly contributes to wasting.