Chapter 25 - Energy Expenditure and Substrate Oxidation in Subjects with Human Immunodeficiency Virus Treated with Antiretroviral Drugs

Abstract

Resting energy expenditure (REE) represents 60% to 70% of total energy expenditure (TEE). In asymptomatic adults with HIV, both on and off antiretroviral drugs, REE may be increased by approximately 10%. The etiology of this hypermetabolism requires future investigation. In practice, it is important to determine TEE to prescribe the correct amount of calories for weight gain or weight maintenance. To our knowledge, only two studies have evaluated the concordance of REE between indirect calorimetry and prediction equations. One study showed that existing equations were unable to predict REE accurately, and the other showed that Melchior equations could be used in clinical practice (for Brazilian subjects with HIV). Those with HIV using antiretroviral drugs may also have altered substrate oxidation, with higher carbohydrate oxidation and lower lipid oxidation. Nutritional intervention is important to maintain weight. Energy intake and physical activity should be assessed and high-quality diets offered to minimize metabolic abnormalities.