The imbalance of GH-IGF-I axis and adrenal- axis in HIV-infected patients

The imbalance of GH-IGF-I axis and adrenal- axis in HIV-infected patients

NUTRITION AND HIV INFECTION-POSTER PRESENTATIONS 277 P-03 P-04 P ENEL, P DRUART, S BASSO, I POIZOT-MARTIN CISIH H&II-Dieu. 6 Place Daviel, 1322...

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NUTRITION

AND

HIV INFECTION-POSTER

PRESENTATIONS

277

P-03

P-04

P ENEL, P DRUART, S BASSO, I POIZOT-MARTIN CISIH H&II-Dieu. 6 Place Daviel, 13224 Marseille Cedex 2. FRANCE WEIGHT EVOLUTION THROUGH THE DM12 DATA BASE, OF HIV INFECTED PATIENTS IN HIV HOSPITAL SERVICES OF THE CENTER FOR 1NFORMATION AND CARE OF HUMAN IMMUNODEFICIENCY (CISIH) OF MARSEILLE DM12 is a computer program designed by the AIDS mission at the FrenchMinistry of Health. It is designed to register anonymously the clinical, epidemiological, therapeutic and economical data from patients infected by HIV. DM12 is set up in the main HIV public hospital services. It enables to follow the evolution of pathology, the use of the care services and the therapeutic modalities. It therefore becomes a work-tool for care planning. For instance the setting up of a nutritional care program for HIV patients within hospital ~111 used DM12 data bank. It is to this purpose that the Center for Information and Care of Human Immunodeficiency (CISIH) of Marseille (rallying the main HIV hospital services) has undertaken a DM12 investigation for access the gradual deterioration of nutritional state. It is to ertimate the percentage of the patients who, from the beginning and during the evolution of the pathology, absolutely need personalized dietetic help and specific nutritional assistance. So the nutritional care program being put into place in the hospitals of Marseille will be able to be adapted to the patients needs. We chose the 443 patients who came for the first time in the HIV services of the CISIH during the year 1994 with a date of first seropositivity within 1993 and 1994. The evolution of the weight during the medical treatment is effected in the percentage of weight loss by five percent and ten percent. We analysed the data in terms of sex. main transmission groups and rate of CD4. We will give the final results at the congress.

M PI’ITIRUTI, M AGRESTI, M TUMBARELLO, M FANTONI Dept of Surgery. Catholic University. Large Gemelli 8, Roma, ITALY USE OF THE GROSHONG CATHETER FOR LONG TERM VENOUS ACCESS IN HIV PATIENTS Tunnellized central venous catheters (CVC) such as Groshong or Hickman have simplified the management of HIV patients requiring home parenteral nutrition or chronic i.v. therapy. We report our experience with 47 Groshong CVC inserted in 46 HIV patients (44 adults, mean age 32 yrs; 2 children): all CVC were inserted at bedside, with local anesthesia, by percutaneous incannulation of internal jugular vein (n=20, low lateral approach), subclavian vein (a= 15, infra-clavicular or supraclavicular approach) or femoral vein (II= 12). In 30 cases, there was a multiple indication for chronic venous access (parenteral nutrition + chemotherapy + other i.v.treatments); parenteral nutrition was the sole indication only in 5 cases. In 12 cases out of 47, the Groshong was inserted not by direct venipuncture but through guidewire replacement of a previously inserted short term CVC. We observed 2 early complications related to CVC insertion (one pneumothorax; one malposition of the tip of the CVC), both after subclavian venipuncture. With regards to late complications, we observed 3 non-infectious complications, all in CVC inserted by the femoral route (one irreversible CVC obstruction due to lipid aggregates; 2 cases of thrombosis of the vein), as well as 4 infectious complications which required removal of the CVC. In most cases (n=40) the patients died while the CVC was still on site and functioning. We think that in HIV patients external tunnellized CVC have several advantages if compared to totally implantable devices (ports): a) easy and rapid bedside insertion; b) minimal rate of early and late complications, especially if the CVC is inserted through the internal jugular vein; c) easy utilization of the central venous access. even by non-trained personnel; d) no risk for the medical staff, since the CVC can be accessed without using needles; e) easy infusion of large volume of fluids, a\ sometimes required in parenteral nutrition. Furthermore, the Groshong catheter. due to its valve, has some advantages if compared to standard open-ended CVC such as Hickman: there is no need for heparinization, as well as no risk of ‘backbleeding’ or air embolism; this implies a safer and simpler management of the central venous access.

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MC THIOYE, I THIOR. TARDY, S DIAO, I NDOYE Projet MST / SIDA, BP 3435 Dakar. SENEGAL NUTRITION OF PROSTITUTES LIVING WITH HIV/AIDS IN A SEXUALLY TRANSMITTED DISEASES CENTER Objectwes: to help prostitutes living with HIV/AIDS live longer; to educate them about nutrition; to list their nutrition-related problems Methods: site: center MST (Sexually transmitted diseases center), institut d’hygiene sociale, Dakar. Population: registered prostitutes living with HIV/AIDS; Beginning of nutritional education in 1989 Nutritional education sessions. During post counselling stage: questionnaire on pre and post counselling nutrition; chart based on food that provides energy; chart based on vitamins and minerals; chart based on foods to avoid. Results: gain of weight for certain prostitutes: reduced alcohol consumption; reduced consumption of tobacco, manufactured food, tinned food, refined food, etc. A good health for wme of them and an adaptation to African traditional food. Over 400 prostitutes living with HIV/AIDS and registered for the social and sanitary prostitution index have benefited from this experiment. Conclusion: this experiment is not to be neglected for the people living with HIV/AIDS. Recommending a good nutrition allows them to live longer and to stay healthy. A sound nutrition is one of the remedies.

D SCEVOLA, M RONDANELLI, SB SOLERTE, L OBERTO, E FERRARI Istituto di Clinica di Malattie Infettive. IRCCS Policlinico S.Matteo, Universite di Pavia, ITALY THE IMBALANCE OF GH-IGF-I AXIS AND ADRENALAXIS IN HIVINFECTED PATIENTS Interactions between the immune system, the central nervous system, and the endocrine system are orchestrated by hormone responses and by a network of cytokines and their receptors. Thus disturbance in signaling and the cellular response to signals in these network may account for at least some of the pathophysiology of the HIV syndrome and in particular may be involved as a causative factor of wasting syndrome. On this background, we start on a study in order to evaluate, in a group of HIV infected patients, the hormones demonstrated involved in the regulation of the immune system: the GH-IGF-I axis and the hypophysisadrenal axis ( ACTH cortisol, DHEA, DHEA-S, aldosterone). The patients group consisted of 13 HIV-infected inpatients (mean age + SD 34 i 16 y) classified CDC C3 with cachexia. The control group were matched for age, sex and ethnic origin. The results of the study demonstrated a massive alterations of the endocrine system. In fact higher basal GH and lower IGF-I and IGFBP3 levels were found in AIDS patients compared with healthy controls. This result may suggest the hormonal involvement in the increased catabolic pattern present during HIV infection. As regard to the adrenal axis, elevated basal cortisol levels and lower DEHA-S and DHEA levels were found in AIDS patients than in controls. Mean levels of ACTH and aldosterone were similar among patients and controls. These results show an important imbalance in the endocrine system during HIV infection. Such embalance may be one of the major causative factor of the constellation of metabolic and immune alteration found in HIV infection secondary to an overthrow of the physiological cross-t&k present between the immune and the endocrine system. In addition, the endocrine pattern found in this study suggests the presence of an hormonal immunosuppressive controregulatory mechanism probabily present in order to prevent the aggressive replication of HIV into the immune system.