HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy.
BACKGROUND
A decrease in the rate of human immunodeficiency virus (HIV) infection-related wasting has been reported in the era of highly active antiretroviral therapy (HAART). We investigated this concern in a hard-to-reach population of HIV-infected drug users in Miami, Florida.


METHODS
After informed consent was obtained, 119 HIV-infected drug users were administered questionnaires involving demographic, medical history, and food-security information. Blood samples were drawn for immunological and viral studies. HIV-related wasting over a period of > or =6 months was defined as a body mass index of <18.5 kg/m2, unintentional weight loss of > or =10% over 6 months, or a weight of <90% of the ideal body weight.


RESULTS
The prevalence of HIV-related wasting was 17.6%. A significantly higher proportion of those who experienced wasting (81%) reported that there were periods during the previous month when they went for > or =1 day without eating (i.e., food insecurity), compared with those who did not experience wasting (57%). Although a greater percentage of patients who experienced wasting were receiving HAART, their HIV RNA levels were more than twice as high (mean+/-standard deviation [SD], 166,689+/-238,002 copies/mL; median log HIV RNA level +/- SD, 10.2+/-2.7 log10 copies/mL) as those for the group that did not experience wasting (mean+/-SD, 72,156 +/- 149,080; median log HIV RNA level+/-SD, 9.2+/-2.3 log10 copies/mL). Participants who experienced wasting were more likely to be heavy alcohol drinkers and users of cocaine. In multivariate analysis that included age, sex, food security, alcohol use, cocaine use, viral load, and receipt of antiretroviral therapy, the only significant predictors of wasting were > or =1 day without eating during the previous month (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.18-3.26; P=.01) and viral load (OR, 1.64; 95% CI, 1.00-2.69; P=.05).


CONCLUSIONS
HIV-related wasting continues to be common among HIV-infected drug users, even among HAART recipients. Food insecurity and viral load were the only independent predictors of wasting. The social and economic conditions affecting the lifestyle of HIV-infected drug users constitute a challenge for prevention and treatment of wasting.
Campa
Adriana
A
Florida International University, College of Health and Urban Affairs, Miami, Florida 33199, USA. campaa@fiu.edu
Yang
Zhifang
Z
Lai
Shenghan
S
Xue
Lihua
L
Phillips
J Craig
JC
Sales
Sabrina
S
Page
J Bryan
JB
Baum
Marianna K
MK
D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D004032:Diet; D005260:Female; D005431:Florida / Q000453:epidemiology; D019247:HIV Wasting Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011788:Quality of Life; D012367:RNA, Viral; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications*; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral