Simply increasing energy intake by oral, enteral, or parenteral routes does not consistently restore LBM in individuals with HIV infection. Failure to increase LBM was particularly evident in a group of patients with systemic infections, predominantly cytomegalovirus or M. avium complex, who were given total parenteral nutrition (TPN) (33). These individuals gained weight while receiving TPN, but they experienced no net increase in BCM, estimated by total body potassium counting. In contrast, patients with malabsorptive disorders but no systemic infection gained weight and BCM. These results were recently confirmed in a study in which administration of TPN to patients with diarrhea or other obstacles to enteral supplementation produced increases in weight and LBM during two months of therapy (34).
Similarly, although treatment with the appetite stimulant, megestrol acetate, has produced increases in energy intake and body weight in patients with HIV-associated wasting (35,36), the weight gain in patients treated with this agent consists predominantly or exclusively of fat. For example, in one recent trial, treatment with megestrol acetate (800 mg/d for 12 wk) resulted in a 4.5 kg increase in fat with no change in LBM (36). In another trial, weight gain averaged 3.5 kg, but only 1.1 kg was LBM and the remainder, fat (35). Although increases in body fat in this setting may not be intrinsically harmful, there is no correlation between body fat content and survival (5,9).
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