From:
RITA! Weekly Newsletter: November 11, 2002
rita@centerforaids.org

Weight Loss Remains an Important Predictor of Mortality"
HIVandHepatitis.com (11/08/02) Boyle B

See also: http://www.aegis.com/channel/s/AD030325.html

Prior to the availability of highly active antiretroviral therapy (HAART),
AIDS wasting led to significant morbidity and mortality among HIV-infected
patients. Since HAART became available, many clinicians have seen a
decline in the incidence and severity of wasting, but several studies have
shown that wasting continues to be a problem, even in patients
successfully treated with HAART.

In a study published in the Journal of Acquired Immune Deficiency
Syndromes (31, p. 230, 2002), investigators attempted to determine
if HIV-related wasting is associated with decreased survival in patients
receiving HAART and, if so, which measurement of wasting, including
overall weight, fat-free mass, body cell mass, or fat mass, is most predictive
of mortality.

The study enrolled 678 HIV-positive participants and weight, fat-free mass,
body cell mass, and fat mass were measured at 6-month intervals.
The investigators used Cox proportional hazards models to estimate and
compare the relative risks of death for each weight-related and adjust for
potential confounders including HAART use, body mass index, and
CD4+ T cell counts.

The investigators found that weight loss was the strongest independent
predictor of mortality. In particular, weight loss of at least 10% from the
patient's baseline or the previous visit was significantly associated with
up to a 6-fold increase in mortality compared with maintenance or gaining
of weight. In addition, even one episode of weight loss of at least 3% from
baseline or at least 5% from the previous visit was also predictive of mortality.

The authors conclude, "despite the apparent benefits of HAART use on
HIV-related survival, weight loss remains an independent predictor of mortality.

In addition, fat-free mass or body cell mass estimated using bioelectrical
impedance analysis does not add further prognostic value over weight loss."