Body-fat measurement in patients with acquired immunodeficiency syndrome: which method should be used?

Malnutrition is common in patients with acquired immunodeficiency syndrome (AIDS), which distorts the chemical contents in the fat-free mass (FFM) and alters the assumptions underlying the traditional methods for calculating body-fat content so that such measurements may not be accurate. In vivo neutron-activation analysis (IVNA) measures FFM independently of the traditional assumptions, thereby providing more accurate measurements of body fat. We compared seven methods for measuring body fat in 18 male patients with AIDS: IVNA, total body water (TBW by 3H2O dilution), total body potassium (TBK by 40K counting), dual-photon absorptiometry (DPA), bioelectrical impedance analysis (BIA), and two well-calibrated anthropometric methods.

Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome. Characterization and treatment with corticosteroids.

Study objectives were to characterize the clinical syndrome of chronic idiopathic esophageal ulceration in patients with acquired immunodeficiency syndrome (AIDS), to determine the extent of local human immunodeficiency virus (HIV) infection, and to evaluate the effect of corticosteroid therapy upon symptoms and healing. Twelve AIDS patients with chronic esophageal ulcers whose etiology remained unknown after clinical evaluation were the subjects. All patients complained of severe odynophagia, chest pain, and weight loss.

Systemic dissemination by a newly recognized intestinal microsporidia species in AIDS.

Objective: Primarily to determine whether an intestinal microsporidian recently identified in AIDS patients disseminates from the bowel to infect other organs.

Design: Disseminated microsporidiosis has been reported in immunocompromised humans, but never due to Enterocytozoon bieneusi, the most common species in AIDS patients and one that evidently infects only enterocytes. In animals, dissemination follows ingestion of Encephalitozoon cuniculi spores, apparently via macrophages, and pathology occurs in, for example, kidneys and brain.

Identification and partial purification of a lectin on the surface of the sporozoite of Cryptosporidium parvum.

A human-derived isolate of Cryptosporidium parvum from a symptomatic patient with the acquired immunodeficiency syndrome was expanded in vivo by infecting a neonatal calf with 10(8) oocysts. Sporozoites were isolated from 4 x 10(10) oocysts harvested from this single infection, and the characteristics of mixed hemagglutination (HA) with rabbit erythrocytes were determined. Sporozoite HA was inhibited by bovine submaxillary mucin (BSM), hog gastric mucin, and orosomucoid, but not by simple sugars, including sialic acid.

Rectal mucosal pathology varies with human immunodeficiency virus antigen content and disease stage.

Rectal mucosal biopsy specimens from 75 human immunodeficiency virus (HIV)-seropositive and 16 HIV-seronegative subjects were examined. The histopathologic changes were correlated with immunoperoxidase staining for UCHL-1 and HIV core protein p24, quantitative p24 enzyme-linked immunosorbent assay (ELISA) assay in homogenized rectal tissue and serum, and a modified Walter Reed clinical stage. Four phases were seen in the HIV-infected subjects: (1) early phase, in Walter Reed stage 1-2 subjects, with nearly normal histology and low p24; (2) inflammatory phase, typically in Walter Reed stage 3-4 subjects, with a superficial lamina propria infiltrate of lymphocytes, plasma cells, and eosinophils with degranulation, abundant UCHL-1 staining, and maximal p24 by both immunoperoxidase staining and ELISA; (3) transitional phase, in many Walter Reed 5 and some Walter Reed 6 subjects, with normal lymphocyte population density but with subtle inflammatory changes; and (4) lymphoid depletion phase, mainly in Walter Reed stage 6 subjects, with decreased lymphocytes but often with endothelial cell activation and apoptosis.

A microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome patient.

To date, the only microsporidian that has been associated with diarrhea and weight loss in acquired immunodeficiency syndrome patients is the newly identified Enterocytozoon bieneusi. A second species is now described that was associated with intestinal symptoms in a 32-year-old, human immunodeficiency virus- seropositive, Native American male homosexual. Stool studies and routine light microscopy of multiple small intestinal biopsies that showed atrophy with acute and chronic inflammation were without apparent pathogens.

Nutritional effects and support in the patient with acquired immunodeficiency syndrome.

Studies of body composition in acquired immunodeficiency syndrome (AIDS) patients demonstrated body cell mass depletion out of proportion to losses of body weight or fat. The timing of death from wasting was related to the extent rather than the specific cause. However, some patients remain stable for indefinite periods, indicating that wasting is not a constant phenomenon.

Localization of infection by the microsporidian Enterocytozoon bieneusi in the gastrointestinal tract of AIDS patients with diarrhea.

Objective: We compared the level of Enterocytozoon bieneusi infection at different sites within the small intestine among patients with AIDS.

Design: The level of E. bieneusi infection of each patient biopsy was determined and compared using semi-thin plastic section light microscopy and transmission electron microscopy (TEM).

A comparison of two microsporidian parasites in enterocytes of AIDS patients with chronic diarrhea.

Enterocytozoon bieneusi was first described by electron microscopy in 1985 in intestinal biopsies from an AIDS patient. It has subsequently been observed in many AIDS patients with chronic diarrhea from the U.S.

Lymphoid organs function as major reservoirs for human immunodeficiency virus.

The total number of human immunodeficiency virus type 1 (HIV-1)-infected circulating CD4+ T lymphocytes is considered to be a reflection of the HIV burden at any given time during the course of HIV infection. However, the low frequency of HIV-infected circulating CD4+ T lymphocytes and the low level or absence of plasma viremia in the early stages of infection do not correlate with the progressive immune dysfunction characteristic of HIV infection. In this study, we have determined whether HIV-infected circulating CD4+ T lymphocytes are a correct reflection of the total pool of HIV-infected CD4+ T cells (i.

Detection, localization, and quantitation of HIV-associated antigens in intestinal biopsies from patients with HIV.

This study determined the prevalence, cellular localization, and content of human immunodeficiency virus (HIV)-associated antigens in intestinal mucosa from HIV-infected subjects. Studies were performed in 168 subjects with gastrointestinal, nutritional, or proctologic complaints, and HIV-seronegative controls. The polymerase chain-reaction technique, which detects viral DNA, was used in 20 subjects and was positive in 70%.

Circulating interferon-alpha levels and hypertriglyceridemia in the acquired immunodeficiency syndrome.

Purpose: The metabolic disturbances seen during infection are thought to be due to cytokines, modulators of the immune response. The acquired immunodeficiency syndrome (AIDS) is characterized by a high prevalence of hypertriglyceridemia and at times depletion of body cell mass (wasting). Elevated circulating levels of cytokines have also been reported in AIDS.

Enteral alimentation and repletion of body cell mass in malnourished patients with acquired immunodeficiency syndrome.

The aim of this study was to determine the feasibility, tolerance, and efficacy of enteral feeding in malnourished AIDS patients. This was a prospective study of eight AIDS patients with severe eating disorders associated with systemic diseases. A defined diet was administered through an endoscopically placed gastrostomy tube.

Cytomegalovirus colitis and wasting.

Disseminated cytomegalovirus (CMV) infection is associated with significant and progressive depletion of body cell mass and body fat in patients with the acquired immune deficiency syndrome (AIDS). In a study examining the effect of ganciclovir on wasting in AIDS patients with disseminated CMV infection, it was found that patients receiving ganciclovir had significant improvement in such variables as body cell mass, body fat, body weight, and total body energy content when compared with those not receiving ganciclovir. The repletion of body cell mass observed in AIDS patients with disseminated CMV infection who are successfully treated with ganciclovir appears to be associated with improved quality of life and prolongation of survival.

Malnutrition in patients with AIDS.

Malnutrition is a frequent problem in persons infected with the human immunodeficiency virus. The origin of malnutrition in patients with AIDS may be multifactorial. The primary mechanisms include disorders of food intake, alterations in intermediary metabolism, and nutrient malabsorption.

Small intestinal injury and parasitic diseases in AIDS.

Objectives: To examine jejunal biopsies from patients with the acquired immunodeficiency syndrome (AIDS), chronic diarrhea, and weight loss, and to correlate the presence of small intestinal injury with pathogens, histopathologic changes, and absorption.

Design: Prospective analysis of jejunal biopsies from 43 patients with AIDS, 10 patients with AIDS-related complex, and 6 heterosexual control volunteers. The biopsies were examined for pathogens; electron microscopy was used in 22 patients.

Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome.

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients.