Body mass index at time of HIV diagnosis: a strong and independent predictor of survival.
BACKGROUND
Identification of basic prognostic indicators of HIV infection is essential before widespread antiretroviral therapy can be implemented in low-technology settings. This study assessed how well body mass index (BMI:kg/m2) predicts survival.


METHODS
BMI within 3 months of HIV diagnosis was obtained from 1657 patients aged > or = 15 years, recruited in a seroprevalent clinical cohort in The Gambia since 1992 and followed up at least once. Baseline CD4+ counts and clinical assessment at time of diagnosis were done.


RESULTS
The mortality hazard ratio (HR) of those with a baseline BMI <18 compared with those with a baseline BMI > or = 18 was 3.4 (95% CI, 3.0-3.9). The median survival time of those presenting with a BMI <16 was 0.8 years, in contrast to a median survival of 8.9 years for those with a baseline BMI > or = 22. Baseline BMI <18 remained a highly significant independent predictor of mortality after adjustment for age, sex, co-trimoxazole prophylaxis, tuberculosis, reported wasting at diagnosis, and baseline CD4+ cell count (adjusted HR = 2.5, 95% CI 2.0-3.0). Sensitivity and specificity of baseline BMI <18 was comparable to that of a CD4+ count <200 in predicting mortality within 6 months of diagnosis.


CONCLUSIONS
BMI at diagnosis is a strong, independent predictor of survival in HIV-infected patients in West Africa. In the absence of sophisticated clinical and laboratory support, BMI may also prove a useful guide for deciding when to initiate antiretroviral therapy.
van der Sande
Marianne A B
MA
Medical Research Council Laboratories, Fajara, Banjul, The Gambia. mvdsande@mrc.gm
Schim van der Loeff
Maarten F
MF
Aveika
Akum A
AA
Sabally
Saihou
S
Togun
Toyin
T
Sarge-Njie
Ramu
R
Alabi
Abraham S
AS
Jaye
Assan
A
Corrah
Tumani
T
Whittle
Hilton C
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000401:mortality* / Q000628:therapy; D006679:HIV Seropositivity / Q000276:immunology / Q000378:metabolism*; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016019:Survival Analysis