Weight loss associated with increased risk of death for HIV patients even in HAART era

Wasting is still associated with an increased risk of death in people with HIV, even when HAART is used, according to a study conducted at Tufts University in the USA published in the Journal of Acquired Immune Deficiency Syndromes.

Investigators monitored a group of 552 people with HIV at six-monthly intervals between 1995 and 2000, with the aim of finding out if wasting was associated with an increased risk of death even when antiretroviral drugs were used, and what measurements of wasting most accurately predicted an increased risk of death.

At baseline the study population had an average CD4 count of 352 cells/mm³, and mean viral load was a little under 80,000 copies/mL. The average age was 40 and 56% of the cohort were men, 32% had experience of IV drugs and 28% were women. Two thirds of the study population had an AIDS-defining illness at baseline. HAART was being used by 44% (210) of participants when they entered the study and was started by an additional 216 people during follow-up.

Excluded from the study were people with cancers other than KS, diabetes and thyroid problems.

The study involved six-monthly check-ups when participants were weighed and had their height measured. Blood tests were also taken for immunological and nutritional testing and a questionnaire asking about social status, HAART, and drug use was administered.

In order to assess their value in predicting mortality, measurements to assess fat-free mass, body cell mass and fat mass were also taken.

Wasting was divided into three categories: up to 3% of body weight; 3% to 4%; 5% to 9% and 10% or above of body weight (an AIDS defining condition).

Over the five years of the study, 40 people died from HIV-related conditions. Investigators found that even when HAART usage was taken into account and adjustments were made for CD4 count, social status and drug use, wasting remained a strong predictor of an increased risk of death.

In particular, the investigators further found that “weight loss of at least 5% over six months or 3% from baseline is significant enough to predict poor prognosis.”

The study also found that looking at fat-free mass, body cell mass or fat mass was of no added prognostic value, suggesting that the methodology of the study did not allow the researchers to discriminate between the effects of weight loss due to fat wasting compared to wasting of muscle mass. Further research is needed to clarify this important issue.