When calculating a BEE for a pt with HIV/AIDS, what is the injury factor that you should use?

This is another one of those "depends on who you talk to" types of questions. So, you will forgive me if I talk around it a bit...

BEE is "basal energy expediture" which can be estimated through calculation or measurement. The result is expressed in calories (energy) and not in protein (one type of energy nutrient -- the other two are carbohydrate and fat). When using standing calculations to estimate BEE we can add an activity factor (that helps to add on calories for the amount of activity a person experiences, such as bed-bound, sedentary, moderate activity, strenuous activity, and so on). We can also add an injury factor to account for the extra energy (calories) that may be needed during infection or injury.

HIV is a difficult case because the "injury factor" is not as simple as one size fits all. If HIV is well controlled and there is no apparent opportunistic infection then the amount of additional energy used may be lower than when HIV viral load is high and opportunistic infection or cancers are present. Malabsorption or decreases in intake may lead to a lower level of calorie requirements for maintenance (though maintenance may not be your goal). When infection is overlaid by starvation (through malabsorption or lack of food intake), then the additional need for calories may fall somewhere inbetween.

Research is conflicting on what people with HIV infection need in general. If it is a crucial thing to calculate, you may want to take the step to have it measured. If it helps at all, a report published by the Food and Nutrition Technical Assistance (FANTA) suggests an additional 10-15% calorie needs for persons who are HIV infected.

As for protein requirements (the subject line of your question), these generally increase in infection. FANTA suggests a 50-100% increase in protein needs. There are many reasons why this may occur... increase in energy requirements, malabsorption and decreased protein source from gut turnover, and increases in protein turnover.

Once again, however, one size does not fit all and protein requirements vary according to not just baseline needs, but tolerance in consideration with other health challenges, such as kidney involvement.

Monitoring the maintenance and restoration of weight and body composition and well as some laboratory evaluation may be helpful to establish an appropriate injury factor. But then, things change...

Best wishes in your quest for a simple answer in a complex disease.