HIV's Impact on Women's Physique
Women and men obviously differ in many ways besides sex organs. Differences in the effects of sex hormones result in men being on average more muscular compared to women of the same height and exercise patterns. This contrast in body composition is of particular interest for AIDS and HIV infection. Response to disease involves the whole body, even for infections that are more localized in the organism than is HIV. Energy and protein stores must be mobilized to support the vigorous inflammatory and lymphocyte-based immune responses.
For transient infections, there might be no evident difference between men and women in changes in body composition. But HIV lasts for years, causing a progressively greater disease burden in terms of both HIV levels and opportunistic infections. Wasting, or weight loss accompanied by decline in muscle mass, has long been noted in men with AIDS or advanced HIV infection. Only lately have researchers begun to look at women with HIV to see how their metabolic response to the virus differs from that of men.
A spate of reports on the subject appeared last year, at the Eleventh International Conference on AIDS. Their conclusions were widely divergent. Donald Kotler, M.D., of Columbia-St. Luke's Hospital, New York, co-authored a series of presentations (see abstracts Mo.B.421, Mo.B.1390, Tu.B.2382 and Th.B.4251). The first of these studies compared 279 men and women with AIDS to 1136 HIV-negative controls. Fat-free mass accounted for 51% of the difference in weight between the HIV-positive and the control men compared to only 18% of the difference between HIV-positive and -negative women.
Two much smaller studies conducted by Kathleen Mulligan, M.D., of San Francisco General Hospital reached the opposite conclusion (see abstracts Mo.B.1389 and We.B.181, also Journal of Acquired Immune Deficiency Syndromes, May 1, 1997; 15(1):43-8). Women and men seemed to have equal increases in metabolism, which were accompanied by losses in both fat and protein, without evidence that fat deposits were perversely spared at the expense of protein. Commenting in an interview on her group's observations, Dr. Mulligan said, "Women have more fat, and we thought they would spare lean body mass more. But in the people we studied, men didn't seem to be disproportionately losing lean body mass. "The men with more fat lose more fat, too." Weight loss in AIDS or HIV then would be similar to simple malnutrition, during which the composition of the weight lost depends on the person's initial body composition.
Dr. Kotler countered in another interview, "It may well be that men lose lean and fat, but my own work suggests that women lose mostly fat and not so much lean."
This dispute was further played out at the NIH Conference on AIDS Wasting Syndrome, held this year on May 20 and 21. A large amount of the difference in conclusions could be related to the types of patients studied. Dr. Kotler has suggested that his patients were leaner to begin with than the San Francisco cohort. At first glance, it seems unlikely that San Franciscans are fatter than New Yorkers, except that the proportion of people with HIV who are from drug using and impoverished backgrounds is much higher in New York. (One of the New York studies presented at the Eleventh International Conference, abstract 1390, was specifically in "substance abusers.")
More importantly, the San Francisco investigators did not look at people with acute opportunistic infections, who experience rapid weight loss accompanied by restricted energy intake. Greater lean body masses might well occur in such situations -- they have been noted in non-HIV studies of acute infection. But no one has focused on women experiencing rapid weight loss to see how they might differ from men.
The NIH Conference reached a tacit compromise that wasting syndrome in AIDS is distinguished by a failure to restore lean mass in periods when weight rebounds. As in other instances of cyclic weight loss, eating more may bring one's body back to its normal weight, but the protein stores in lean tissue will remain depleted. Some women, and men, too, who are taking protease inhibitors are now complaining of shrinkage in limb and hip size while new fat bulges appear on their torsos. At the same time, they are gaining or maintaining total weight.
Men have a variety of anabolic agents, including testosterone and synthetic steroids that they can use to reorient their body toward rebuilding lean tissue. Women, who probably also have reduced testosterone levels during HIV infection, could use these compounds too, usually at lower dosages. Knowledge is limited in this area, but at least studies for women are now taking place. Another possibility is embarking on a resistance exercise program, such as weight lifting. This exercise will make your body more sensitive to your natural anabolic hormones, another subject that has been poorly studied in women. At the NIH conference, Tufts University researchers reporting on a small ongoing study of resistance training described weight gains in women and men averaging 3.8%, with 79% of this gain being lean body mass.
Finally, there is the hugely expensive recombinant growth hormone available from Serono Laboratories. It is purportedly sex-neutral, although women may clear the compound more slowly than men. No gender analysis of growth hormone's effects is available: Of the 205 volunteers receiving growth hormone in trials, only five were women.
This article was provided by Gay Men's Health Crisis. It is a part of the publication GMHC Treatment Issues. Visit GMHC's website to find out more about their activities, publications and services.