Early changes of body composition in human immunodeficiency virus-infected patients: tetrapolar body impedance analysis indicates significant malnutrition.

Abstract

In this study the investigators examined alterations in body composition and the prevalence of diarrhea in HIV‐infected subjects. By using tetrapolar body impedance analysis (RJL‐Akern BIA 109:Data‐input, Frankfurt/Main, Germany), body composition was measured in 533 subjects, including 193 men aged 21 to 70 years, who had tested positive for HIV‐1 antibodies and 340 age‐ and sex‐matched control subjects. HIV‐infected patients were grouped according to the Walter Reed (WR) classification of HIV disease stages.1 Total body water, extracellular mass (ECM), body fat, body cell mass (BCM), and ECM/BCM ratio were determined. Relative to control subjects, the body weight and body mass index (BMI) of WR 3 through WR 5 (n = 85) and WR 6 (n = 83) subjects were significantly decreased (p <.29 and P <.001, respectively), whereas WR 2 (n = 26) subjects exhibited no decline in either body weight or BMI. However, all HIV‐infected subjects, including those classified as WR 2, displayed both a statistically significant decline in BCM and an increase in ECM, resulting in an increased ECM/BCM ratio. The use of tetrapolar impedance detected depletion of lean body mass in clinically asymptomatic HIV patients at the WR 2 stage who had not yet demonstrated alterations in body weight or BMI. Malnutrition can be defined as a state of decreased BCM and increased ECM. The altered ECM/BCM ratio is independent of body weight or BMI. Almost half the WR 2 patients had ECM/BCM ratios greater than those of matched control patients by 1 standard deviation. No significant depletion of fat stores was noted in any group except in the most severe WR 6 HIV patients.When patients were classified into four diarrheal states in terms of stool evacuation, consistency, duration, and frequency, only the most severe state (patients with either more than 20 diarrheal episodes of more than 3 days duration or permanent diarrhea during the last year) correlated with the degree of malnutrition.