Discuss the physiological effects of HIV disease and the effect of ARV drugs on the body.

Question

What will be an ideal response?

Answer 1

HIV infection raises resting energy requirements by 9–15 percent. Macro- and micronutrient needs increase with high viral load, decline of immune function, secondary infections, and altered absorption and metabolism. Nutrient malabsorption due to changes in the gut and gastrointestinal pathogens can further compromise nutrient stores. Unmet nutrient needs lead to antioxidant depletion, anemia, and protein-energy malnutrition. Vitamin and mineral supplementation has been found to restore blood concentrations of deficient nutrients, but it did not impact measures of viral load or disease mortality. There is a loss of lean tissue (e.g., muscle mass) throughout the HIV disease process regardless of weight maintenance or weight gain. Many people are overweight or obese at diagnosis and others experience significant weight gain after initiation of ARV, resulting in an obesity rate of 60–70 percent in this population. Obesity in HIV is associated with increased morbidity, but not increased mortality. The introduction of ARV drugs was associated withlipodystrophy—a redistribution of body fat stores. HIV-associated lipodystrophy is characterized by lipoatrophy, lipohypertrophy, "buffalo hump," and lipomas. Lipoatrophy is reversed or avoided with newer classes of ARV drugs, but gradual and persistent lipohypertrophy is common. The newer ARV drugs are less toxic on cellular structure, but induce other metabolic abnormalities, including glucose impairment and bone disorders.