INCIDENCE AND PROGNOSTIC VALUE OF MALNUTRITION AND WASTING IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED OUTPATIENTS

Although malnutrition and wasting are known features of human immunode ficiency virus (HIV) infection, their incidence and possible associati on with immunologic impairment are largly unknown, as is the prognosti c value of the nutritional state. Nutritional, clinical, and immunolog ic parameters were measured in 100 outpatients in different stages of HIV infection. In addition, 39 patients with AIDS were prospectively f ollowed for a mean period of 343 (range, 53-650) days. Sixty-three per cent of the patients showed evidence of malnutrition, 21% suffered fro m wasting. A reduced body cell mass and decreased serum albumin levels were observed in 32 and 14%, respectively, predominantly in more adva nced disease stages. Fourteen of 39 AIDS patients died after a mean su rvival of 212 days. Survivors showed significantly larger initial body cell mass values and higher initial serum albumin levels compared wit h nonsurvivors, whereas CD4(+) lymphocyte counts, disease complication s, and medication were all similar in both groups. Kaplan-Meier analys es revealed a significantly prolonged survival in patients with a body cell mass >30% of body weight or serum albumin levels exceeding 30 g/ L. Factor analyses indicated that the parameters of nutritional state were independent from each other and from CD4(+) lymphocyte counts. Ma lnutrition occurs frequently during HIV infection and increases with d isease progress. It strongly predicts patient survival independent of CD4(+) lymphocyte counts.