Body mass index course in asymptomatic HIV-infected homosexual men and the predictive value of a decrease of body mass index for progression to AIDS

Abstract

Weight loss is a common characteristic of advanced stages of HIV infection. Weight changes during the asymptomatic stage of HIV infection have not been well documented and the possible predictive value of early weight loss for progression to AIDS is unknown. In 122 HIV seroconverters, the natural course of body mass index (BMI) following seroconversion was studied. No BMI decline was seen immediately following seroconversion. In the 56 AIDS cases, however, a steep BMI decline of 1.14 kg/m2 occurred 6 months before AIDS. This BMI decline was more pronounced in those with low CD4+ T cell counts (<100 x 10(6)/L) at the time of AIDS diagnosis (1.8 kg/m2). The relative hazard for progression to AIDS of a BMI decline of 1.14 kg/m2 per 6 months was 3.1, which remained similar after adjustment for CD4 count and p24 antigenemia. We conclude that the course of BMI in HIV-1 infection is biphasic: a relatively stable period is followed by a rapid decline in the 6 months preceding onset of AIDS. Furthermore, we found that this steep BMI decline was associated with faster progression to AIDS.

PIP: The possible predictive value of weight loss during the asymptomatic stage of HIV infection for progression to AIDS was assessed in 122 HIV seroconverters from the Netherlands. Study subjects were part of a broader cohort study initiated in 1984 of initially seronegative homosexuals from Amsterdam. The mean age of seroconverters was 35.8 years, with a mean follow-up time between seroconversion and AIDS diagnosis of 5.3 years (range, 0.6-10.8 years). The mean body mass index (BMI) was 22.2 kg/sq. mm at the first HIV-positive visit and 21.0 kg/sq. mm at AIDS diagnosis. Overall, there was no immediate decline in BMI in the immediate postseroconversion period. However, in the 56 men who progressed to AIDS, a BMI decline of 1.14 kg/sq. mm occurred 6 months before diagnosis. This decline was even more pronounced (1.8 kg/sq. mm) in those with CD4 T cell counts under 100 at the time of AIDS diagnosis. The relative hazard of progression to AIDS of a BMI decline of 1.14 kg/sq. mm per 6 months was 3.1. This rate persisted after adjustment for CD4 count and p24 antigenemia. Although the sensitivity of weight loss is only about one third, when weight loss is present, it can be considered a useful marker of progression to AIDS. It could not be established from this study whether weight loss was an early manifestation of an AIDS-defining illness or a true pre-AIDS decline. Initiation of antiretroviral therapy should be considered before the first signs of weight loss appear.