PROCAARE: CLINICAL SCIENCE--Nutrition

["Gerard J. Nau (Jerry)" <gnau@usa.healthnet.org>]

KEYWORDS--NUTRITION/PARENTERAL/TPN/WASTING
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Reference:  Melchior, J., Chastang, C., Gelas, P., Carbonnel, F., Zazzo, 
J., Bouler, A., Cosnes, J., Bouletreau, P., and B. Messing.  (1996)  
Efficacy of 2-month total parenteral nutrition in AIDS patients: a 
controlled randomized prospective trial.  AIDS 10:379-384.

This study evaluated the efficacy of total parenteral nutrition (TPN) in 
treating AIDS patients suffering from malnutrition.

Thirty-one patients were randomized to receive home TPN therapy (16) or 
dietary counseling (15).  The group was highly select: patients with CD4 
counts less than 200 million/L, with bodyweight loss of more than 10% of 
pre-illness, and who had diarrhea and/or the inability to take oral 
nutrition were included.  Patients actively taking injection drugs or 
excessive alcohol, who were undergoing chemotherapy for lymphoma or 
KaposiÕs sarcoma, who had major illness such as psychiatric or renal or 
hepatic failure were excluded.  Patients were treated for 6 nights per 
week for 2 months.  The outcomes assessed were lean body mass 
measurements, nutritional subjective global assessment, and subjective 
health of the participants.

Administration of TPN increased all measures of body composition compared 
to the control group where they decreased.  These measures included total 
body weight (average 8 kg increase versus 3 kg decrease), lean body mass, 
and body cell mass.  The subjective measures of nutritional state and of 
health feeling also increased in those patients who received TPN.  The 
risk of infection in the group receiving TPN was estimated to be 0.26 per 
100 patient-days.  There was no apparent survival benefit to the TPN therapy.

This report demonstrates a beneficial effect of TPN on a subgroup of AIDS 
patients suffering from malnutrition.  This intervention is undoubtably 
costly and potentially impractical for widespread application.  However, 
these findings indicate that wasting associated with gastrointestinal 
disturbance is due to inability to ingest and/or to absorb sufficient 
nutrition and not necessarily due to an intrinsic catabolic state.