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Lipodystrophy and WastingLipodystrophy and Wasting
          
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ecm
Aug 27, 2002

Cade, You have made reference to ecm usually being elevated in hiv infection. Why is that? Also it usually rises if/when viral load rises. Can you explain the realtionship? Does this mean people with uncontrolled virus will look bloated and fatter due to a rising ecm? Thank you

Response from Ms. Fields-Gardner

In a body composition evaluation by bioelectrical impedance analysis (BIA) an infection or injury can show up as an elevation in extracellular mass (ECM or ECT). The reason for this is the body's physiologic response to physical stress. The parts that significantly contribute to this change in reading include:

1. Breakdown of some body cell mass or BCM (mostly in the skeletal muscle category) to increase an amino acid ("building blocks" of proteins) pool.

2. Creation of inflammatory modulating proteins (cytokines) from the amino acid pool to initiate/activate the body's response.

3. Increase in extracellular fluid volume (this allows transport and processing of immune and healing factors)

In taking a BIA reading we are likely to see the fluids shift before we see a significant loss in BCM. BIA is particularly sensitive to fluid shifts.

This does not mean that with higher viral load you will be bloated and fatter-looking. That would take more than a high viral load to accomplish. A minor example is when you have a scratch on your skin and you see some minor swelling. An exaggerated response can be illustrated by thinking about the edema that occurs in significant burns.

As the assault is resolved, fluids should go back to the expected range. BIA can be useful to monitor for this resolution.

Your response with fluid volume will be dependent on your ability to mount this protective response. If you are simulatneously dehydrated while your fluids shift in response to infection or injury, the BIA may show ECM in the normal range when, in fact, fluids have shifted. To interpret these nuances your clinician should have a good understanding of what moves these compartments and what to look for if the results are not as expected.

Hope that helps!


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