Changes in the incidence and predictors of wasting syndrome related to human immunodeficiency virus infection, 1987-1999.
The authors examined the impact of potent antiretroviral therapy (ART) on the diagnosis of wasting syndrome in the Multicenter AIDS Cohort Study. Study time was divided into the periods 1988-1990, 1991-1993, 1994-1995, and 1996-1999 to correspond to different treatment eras. The proportion of acquired immunodeficiency syndrome diagnoses in which wasting was present increased from 5% in 1988-1990 to 7.1% in 1991-1993, 7.7% in 1994-1995, and 18.9% in 1996-1999. The incidence of wasting per 1,000 person-years increased from 7.5 in 1988-1990 to 14.4 in 1991-1993 and 22.1 in 1994-1995; it decreased to 13.4 in 1996-1999. Fewer patients with wasting had low hemoglobin and hematocrit levels and reported oral thrush in 1996-1999 than in any other period. Analysis of change in body mass index (weight (kg)/height (m)(2)) after wasting showed a faster return to prewasting levels in 1994-1995 and 1996-1999 than in earlier periods. Case-control analysis showed that wasting prior to 1996 was weakly associated with fatigue (p = 0.10), low hemoglobin (p = 0.11), and CD4-positive T-lymphocyte count (p = 0.04). During 1996-1999, wasting was weakly associated with diarrhea (p = 0.05) and potent ART (p = 0.097). Predictors of wasting have changed with potent ART. Further research is needed to determine whether lipodystrophy may be misdiagnosed as wasting syndrome.
Smit
Ellen
E
Department of Social and Preventive Medicine, School of Medicine and Biological Sciences, University at Buffalo, Buffalo, NY 14214-3000, USA. esmit@buffalo.edu
Skolasky
Richard L
RL
Dobs
Adrian S
AS
Calhoun
Bridget C
BC
Visscher
Barbara R
BR
Palella
Frank J
FJ
Jacobson
Lisa P
LP
D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data* / Q000639:trends; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D002180:Candidiasis, Oral / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000188:drug therapy; D019247:HIV Wasting Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged