The use of combination antiretroviral therapy (cART) has improved the prognosis of HIV infection, but it has also been linked to a spectrum of body composition changes and metabolic alterations known as the lipodystrophy syndrome. Nutritional status could influence body composition changes.
Methods
We performed a systematic search of published peer-reviewed data on the effects of diet, nutrition support and exercise on body composition and metabolic complications in patients receiving cART.
Results
Few controlled studies, most of them with small sample size, were found. Oral nutritional support increases protein and energy intake, and results in body weight and fat mass gains. Resistance exercise, with or without an aerobic component, increases lean mass and can improve insulin resistance. Low-fat diets or exercise can result in loss of fat mass, and they should be used with caution in subjects with lipoatrophy.
Conclusions
Nutritional support and exercise result in small but significant body composition changes and can be used as complementary interventions. There is a need for further research on nutritional interventions in HIV-infected patients receiving cART.
References
1.
MelchiorJ.C., NitongamboT., HenzelD.Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients.Nutrition1999; 15: 865–869.
2.
WheelerD.A., GilbertC.L., LaunerC.A.Weight loss as a predictor of survival and disease progression in HIV infection.J Acquir Immune Defic Syndr1998; 18: 80–85.
3.
KotlerD.P., tierneyA.R., WangJ., PiersonR.N.Magnitude of body-cell-mass depletion and the timing of death from easting in AIDS.Am J Clin Nutr1989; 50: 444–447.
4.
PalellaF.J., DelaneyK.M., MoormanA.C.and the HIV Outpatient Study Investigators. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection.N Engl J Med1998; 338: 853–860.
5.
MocroftA., VellaS., BenfieldT.L.Changing patterns of mortality across Europe in patients infected with HIV-1.Lancet1998; 352: 1725–1730.
6.
MocroftA., LederbergerB., KatlamaC.Decline in the AIDS and death rates in the EuroSIDA study: an observational study.Lancet2003; 362: 22–29.
7.
SterneJ.A.C., HerránM.A., LedergerberB.Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study.Lancet2005; 366: 378–384.
8.
DelforgeM.L., FarineS., LiesnardC.Nutritional status and antiprotease therapy.J Acquir Immune Defic Syndr1998; 18: 393–394.
9.
CarrA., SamarasK., BurtonS.A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors.AIDS1998; 12: F51–F58.
10.
MillerK.D., JonesE., YanovskiJ.A., ShankarR., FeuersteinI., FalloonJ.Visceral abdominal-fat accumulation associated with use of indinavir.Lancet1998; 351: 871–875.
11.
LoJ.C., MulliganK., TaiV.W., AlgrenH., SchambelanM.‘Buffalo hump’ in men with HIV-1 infection.Lancet1998; 351: 867–870.
12.
The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group.Combination antiretroviral therapy and the risk of myocardial infarction.N Engl J Med2003; 349: 1993–2003.
13.
WankeC.A., SilvaM., KnoxT.A., ForresterJ., SpeigelmanD., GorbachS.L.Weight loss and wasting remain common complications in individuals infected with human immunodeiciency virus in the era of highly active antiretroviral therapy.Clin Infect Dis2000; 31: 803–805.
14.
TangA.M., ForresterJ., SpiegelmanD., KnoxT.A., TchetgenE., GorbachS.L.Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy.J Acquir Immune Defic Syndr2002; 31: 230–236.
15.
DubéM.P., SprecherD., HenryW.K.Preliminary guidelines for the evaluation and management off dyslipidemia in adults infected with human immunodeficiency virus and receiving antiretroviral therapy: recommendations of the Adult AIDS Clinical Trial Group Cardiovascular Disease Focus Group.Clin Infect Dis2000; 31: 1216–1224.
16.
SchambelanM., BensonC.A., CarrA.Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society-USA Panel.J Acquir Immune Defic Syndr2002; 31: 257–275.
17.
MartinezE., ArnaizJ.A., PodzamczerD.Substitution of nevirapine, efavirenz, or abacavir for protease inhibitors in patients with human immunodeficiency virus infection.N Engl J Med2003; 349: 1036–1046.
18.
CarrA., WorkmanC., SmithD.E.Abacavir substitution for nucleoside analogs in patients with HIV lipoatrophy: a randomized trial.JAMA2002; 288: 207–215.
19.
GallantJ.E., StaszewskiS., PozniakA.L.Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial.JAMA2004; 292: 191–201.
20.
MobiusU., Lubach-RuitmanM., Castro-FrenzelB.Switching to atazanavir improves metabolic disorders in antiretroviral-experienced patients with severe hyperlipidemia.J Acquir Immune Defic Syndr2005; 39: 174–180.
21.
FisacC., FumeroE., CrespoM.Metabolic benefits 24 months after replacing protease inhibitor with abacavir, efavirenz or nevirapine.AIDS2005; 19: 917–925.
22.
BarriosA., BlancoF., García-BenayasT.Effect of dietary intervention on highly active antiretroviral therapy-related dyslipemia.AIDS2002; 16: 2079–2081.
23.
MoyleG.J., LloydM., ReynoldsB., BaldwinC., MandaliaS., GazzardB.G.Dietary advice with or without pravastatin for the management of hypercholesterolemia associated with protease inhibitor therapy.AIDS2001; 15: 1503–1508.
24.
TerryL., SprinzE., SteinR., MedeirosN.B., OliveiraJ., RibeiroJ.P.Exercise training in HIV-1-infected individuals with dyslipidemia and lypodystrophy.Med Sci Sport Exerc2006; 38: 411–417.
25.
EngelsonE.S., AginD., KenyaS.Body composition and metabolic effects of a diet and exercise weight loss regimen on obese, HIV-infected women.Metabolism2006; 55: 1327–1336.
26.
De LuisD., AllerR., BachillerP.Isolated dietary counselling program versus supplement and dietary counselling in patients with Human Immunodeficiency Virus Infection.Med Clin2003; 120: 565–567.
27.
ShevitzA.H., WilsonI.B., McDermottA.Y.A comparison of the clinical and cost-effectiveness of 3 intervention strategies for AIDS wasting.J Acquir Immune Defic Syndr2005; 38: 399–406.
28.
De Luis RománD.A., BachillerP., IzaolaO.Nutritional treatment for acquired immunodeficiency virus infection using an enterotropic peptide-based formula enriched with n-3 fatty acids: a randomized prospective trial.Eur J Clin Nutr2001; 55: 1048–1052.
29.
ClarkR.H., FelekeG., DinM.Nutritional treatment for acquired immunodeficiency virus-associated wasting using β-hydroxy β-methylbutyrate, glutamine, and arginine: a randomized, double-blind, placebo-controlled study.JPEN2000; 24: 133–139.
30.
SutinenJ., WalkerU.A., SevastianovaK.Uridine supplementation for the treatment of antiretroviral therapy-associated lipoatrophy: a randomized, double-blind, placebo-controlled trial.Antivir Ther2007; 12: 97–105.
31.
WohlD.A., TienH-C, BusbyM.Randomized study of the safety and efficacy of fish oil (omega-3 fatty-acid) supplementation with dietary and excercise counselling for the treatment of antiretroviral therapy-associated hypertriglyceridemia.Clin Infect Dis2005; 41: 1498–1504.
32.
De TruchisP., KirstetterM., PerierA.Reduction in triglyceride level with n-3polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy. A randomized prospective study.J Acquir Defic Syndr2007; 44: 278–285.
33.
CarterV.M., WoolleyI., JolleyD., NyulasiI., MijchA., DartA.A randomised controlled trial of omega-3 fatty acid supplementation for the treatment of hypertriglyceridemia in HIV-infected males on highly active antiretroviral therapy.Sexual Health2006; 3: 287–290.
34.
ManfrediR., CalzaL., ChiodoF.Polyunsaturated ethyl esters on n-3 fatty acids in HIV-infected patients with moderate hypertriglyceridemia: comparison with dietary and lifestyle changes, and fibrate therapy.J Acquir Immune Defic Syndr2004; 36: 878–880.
35.
LoignonM., TomaE.l-Carnitine for the treatment of highly active antiretroviral therapy-related hypertriglyceridemia in HIV infected adults.AIDS2001; 15: 1194–1195.
36.
KaiserJ.D., CampaA.M., OndercinJ.P., LeoungG.S., PlessR.F., BaumM.K.Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective double-blinded, placebo-controlled trial.J Acquir Defic Syndr2006; 42: 523–528.
37.
McComseyG., SouthwellH., GripshoverB., SalataR., ValdezH.Effects of antioxidants on glucose metabolism and plasma lipids in HIV-infected subjects with lipoatrophy.J Acquir Immune Defic Syndr2003; 33: 605–607.
38.
DolanS.E., FronteraW., LibrizziJ.Effects of a supervised home-based aerobic and progressive resistance training regimen in women infected with human immunodeficiency virus. A randomized trial.Arch Intern med2006; 166: 1225–1231.
39.
RoubenoffR., WeissL., McDermottA.A pilot study of exercise training to reduce trunk fat in adults with HIV-associated fat redistribution.AIDS1999; 13: 1373–1375.
40.
YarasheskiK.E., TebasP., StanersonB.Resistance exercise training reduces hypertriglyceridemia in HIV-infected men treated with antiviral therapy.J Appl Physiol2001; 90: 133–138.
41.
RoubenoffR., McDermottA., WeissL.Short-term progressive resistance training increases strength and lean body mass in adults infected with human immunodeficiency virus.AIDS1999; 13: 231–239.
42.
DriscollS.D., MeiningerG.E., LareauM.T.Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients.AIDS2004; 18: 465–473.
43.
StrawfordA., BarbieriT., Van LoanM.Resistance exercise and supraphysiologic androgen therapy in eugonadal men with HIV-related weight loss.JAMA1999; 281: 1282–1290.
44.
DriscollS.D., MeiningerG.E., LjungquistK.Differential effects of metformin and exercise on muscle adiposity and metabolic indices in Human Immunodeficiency Virus-infected patients.J Clin Endocrinol Metab2004; 89: 2171–2178.
45.
JonesS.P., DornaD.A., LeattP.B., MaherB., PirmohamedM.Short-term exercise training improves body composition and hyperlipidaemia in HIV-positive individuals with lipodystrophy.AIDS2001; 15: 2049–2051.
46.
SattlerF.R., JaqueS.V., SchroederE.T.Effects of pharmacological doses of nandrolone decanoate and progressive resistance training in immunodeficient patients with human immunodeficiency virus.J Clin Endocrinol Metab1999; 84: 1268–1276.
47.
SattlerF.R., SchroederE.T., DubeM.P.Metabolic effects of nandrolone decanoate and resistance training in men with HIV.Am J Physiol Endocrinol Metab2002; 283: E1214–E1222.
48.
MillerE.R., ErlingerT.P., YoungD.R.Results of the Diet Exercise, and Weight Loss Intervention Trial (DEW-IT).Hypertension2003; 40: 612–618.
49.
MecklingK.A., SherfeyR.A randomized trial of a hypocaloric high-protein diet, with and without exercise, on weight loss, fitness, and markers of the metabolic syndrome in overweight and obese women.Appl Physiol Nutr Metab2007; 32: 743–752.
50.
SvendsenO.L., HssagerC., ChristiansenC.Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight postmenopausal women.Am J Med1993; 95: 131–140.
51.
SchwenkA.Methods of assessing body shape and composition in HIV-associated lipodistrophy.Curr Opin Infect Dis2002; 15: 1–8.
52.
MelroeN.H., KopaczewskiJ., HenryK., HuebschJ.Intervention for hyperlipidemia associated with protease inhibitors.J Assoc Nurse AIDS Care1999; 10: 55–69.
53.
HenryK., MelroeH., Huebesch, HermundsonJ., SimpsonJ.Atorvastatin and Gemfibrozil for protease-inhibitor-related lipid abnormalities.Lancet1998; 352: 1031–1032.
54.
Expert panel on detection, evaluation and treatment of high blood cholesterol in adults.Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III).JAMA2001; 285: 2486–2497.
55.
KnoppR.H., WaldenC.E., RetzlaffB.M.Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. The dietary alternatives study.JAMA1997; 278: 1509–1515.
56.
ChengC., GrazianiC., DiamondJ.J.Cholesterol-lowering effect of the food for heart nutrition education program.J Am Diet Assoc2004; 104: 1868–1872.
57.
ShahM., TierneyK., Adams-HuetB.The role of diet, exercise and smoking in dyslipidemia in HIV-infected patients with lipodystrophy.HIV Med2005; 6: 291–298.
58.
HadiganC., JesteS., AndersonE.L., TsayR., CyrH., GrinspoonS.Modifiable dietary habits and their relation to metabolic abnormalities in men and women with human immunodeficiency virus infection and fat redistribution.Clin Infect Dis2001; 33: 710–717.
59.
EstruchR., Martínez-GonzálezM.A., CorellaD.Effects of a Mediterranean-style diet on cardiovascular risk factors. A randomized trial.Ann Intern Med2006; 145: 1–11.
60.
CarrA., HudsonJ., ChuahJ.HIV protease inhibitor substitution in patients with lipodystrophy: a randomized, controlled, open-label, multicentre study.AIDS2001; 15: 1811–1822.
61.
RuizL., NegredoE., DomingoP.Antiretroviral treatment simplification with nevirapine in protease inhibitor-experienced patients with HIV-associated lipodystrophy: 1-year prospective follow-up of a multicenter, randomized, controlled study.J Acquir Immune Defic Syndr2001; 27: 229–236.
62.
FisacC., FumeroE., CrespoM.Metabolic benefits 24 months after replacing a protease inhibitor with abacavir, efavirenz or nevirapine.AIDS2005; 19: 917–925.
63.
NegredoE., CruzL., ParedesVirological, immunological, and clinical impact of switching from protease inhibitors to nevirapine or to efavirenz in patients with human immunodeficiency virus infection and long-lasting viral suppression.Clin Infect Dis2002; 34: 504–510.
64.
SmithB., NeidigJ.L., NickelJ.T., MitchelG.L., ParaM.F., FassR.J.Aerobic exercise: effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults.AIDS2001; 15: 693–701.
65.
BhasinS., StorerT.W., JavanbakhtM.Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels.JAMA2000; 283: 763–770.
66.
GrinspoonS., CorcoranC., ParlmanK.Effects of testosterone and progressive resistance training in eugonadal men with AIDS wasting.Ann Intern Med2000; 133: 348–355.
67.
O'BrienK., NixonS., GlazierR.H., TynanA.M.Progressive resistive exercise interventions for adults living with HIV/AIDS.The Cochrane Database of Systematic Reviews2004, Issue 4. Article No.CD004248. DOI: 10.1002/14651858.CD004248.pub2.
