Short-term effects of lipid-based parenteral nutrition in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia

The human immunodeficiency virus (HIV) is surrounded by a rigid membrane rich in cholesterol. Extraction of cholesterol from the virus envelope reduces its infectivity in vitro. Large amounts of lipid emulsion phospholipids have the property of extracting cholesterol from cell membranes. The purpose of the present study was to observe the effects of high phospholipid loads on the lipid profile as well as HIV infectivity of patients with acquired immunodeficiency syndrome (AIDS). Fifty-nine patients with AIDS, weight loss, and presenting Pneumocystis carinii pneumonia (PCP) were included in a prospective, randomised, controlled study. In addition to standard therapy, patients received for 2 weeks 910 kcal of peripheral parenteral nutrition including 20% lipid emulsion (group 1) or a new 2% lipid emulsion with a high phospholipid/triglyceride ratio (1:1.7) (group 2). Activity level and biological, immune and HIV load and infectivity parameters were followed. Cholesterol increased from 113 ± 44 to 228 ± 103 mg/dl in the 2% group (P < 0.00001). Triglycerides also increased significantly (P < 0.02). IgA was decreased in the 2% group. HIV load and infectivity tests and leukocyte subsets did not demonstrate any effect of the lipid emulsions. It is concluded that the new 2% emulsion is a powerful cholesterol extractor. However, 2 weeks' administration failed to show any efficacy in modifying immune parameters or HIV infectivity in AIDS patients with PCP.