title: Body mass index at time of HIV diagnosis: a strong and independent predictor of survival.
abstract: 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.
authors.affiliation: Medical Research Council Laboratories, Fajara, Banjul, The Gambia. mvdsande@mrc.gm
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Schim van der Loeff
authors.forename: Akum A
authors.initials: AA
authors.lastname: Aveika
authors.forename: Saihou
authors.initials: S
authors.lastname: Sabally
authors.forename: Toyin
authors.initials: T
authors.lastname: Togun
authors.forename: Ramu
authors.initials: R
authors.lastname: Sarge-Njie
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Alabi
authors.forename: Assan
authors.initials: A
authors.lastname: Jaye
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: Hilton C
authors.initials: HC
authors.lastname: Whittle
mesh_terms: 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