Correspondence
Energy Expenditure in Human Immunodeficiency Virus Infection
N Engl J Med 1997; 336:70-71January 2, 1997
- Article
To the Editor:
Resting energy expenditure has been variably reported as increased,1 inconsistently elevated,2 and decreased3 in patients with human immunodeficiency virus (HIV) infection. The determinants of this variability are not yet understood. Given the evidence that viral load has a strong influence on the progression of HIV infection,4 we evaluated the relation between viral load and resting energy expenditure in a diverse group of 36 HIV-positive men studied while they were relatively stable clinically.
The patients fasted overnight and abstained from caffeine and nicotine on the morning of the study. After arriving at the General Clinical Research Center at San Francisco General Hospital, each rested in bed for 30 minutes, and then his resting energy expenditure was measured for 30 minutes by indirect calorimetry (DeltaTrac, Sensormedics, Yorba Linda, Calif.). Each patient was weighed on a calibrated scale, and his lean body mass was quantitated by dual-energy x-ray absorptiometry (DPX, Lunar Radiation, Madison, Wis.). Viral loads were determined at Chiron Corporation (Emeryville, Calif.) by the Quantiplex 2.0 branched-chain DNA assay for HIV type 1 RNA (courtesy of D. Chernoff, M.D.) in samples of plasma separated from blood collected in tubes containing EDTA.
The patients ranged in weight from 54.1 to 99.5 kg, in body-mass index (calculated as the weight in kilograms divided by the square of the height in meters) from 18.1 to 31.3, in age from 29 to 52 years, and in plasma level of HIV RNA from 500 to 472,000 copies per milliliter. Their resting energy expenditures ranged from 88 percent to 136 percent of the value predicted by the Harris–Benedict equation (mean [±SE], 112±2 percent). There was a significant positive correlation between the plasma level of HIV RNA and the resting energy expenditure, after adjustment for lean body mass (r = 0.404, P = 0.011) (Figure 1Figure 1
Correlation between Plasma HIV RNA Levels and Resting Energy Expenditure in 36 HIV-Positive Men.). The relation between the CD4+ lymphocyte count and the resting energy expenditure was weaker and not statistically significant (r = 0.289, P = 0.092).Because immune activation transiently increases levels of HIV RNA,5,6 we also measured the resting energy expenditure of five HIV-positive men and four HIV-negative men before influenza vaccination and one, two, and four weeks thereafter. In the HIV-positive men, the resting energy expenditure increased by 1.94±0.41 kcal per kilogram of lean body mass per day (peak increase, 5.5 percent), whereas it did not increase in the HIV-negative controls (mean change, -0.51±0.07 kcal per kilogram of lean body mass per day; P = 0.006 for the comparison with the HIV-positive men). Although no quantitative relation between the magnitude of the changes in resting energy expenditure and the viral load could be detected in this small group, our findings suggest that either resting energy expenditure increases as part of the host response to increases in HIV or the increase reflects the exaggerated host immune responses seen in HIV-positive persons. Whether sustained reductions in HIV RNA with potent antiretroviral therapies will decrease the resting energy expenditure and blunt the response to immune activation remains to be determined.
6 ReferencesKathleen Mulligan, Ph.D.
Viva W. Tai, R.D., M.P.H.
Morris Schambelan, M.D.
University of California, San Francisco, San Francisco, CA 94143-13531
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