DIETARY-INTAKE AND COUNSELING, WEIGHT MAINTENANCE, AND THE COURSE OF HIV-INFECTION

Objective To define relationships among dietary intake and counseling, weight maintenance, and the clinical course of patients infected with the human immunodeficiency virus (HIV). Design A prospective cohort s tudy in an HIV clinic in a county hospital. Subjects HIV-infected pati ents (68 with and 40 without acquired immunodeficiency syndrome [AIDS] ) who had a good performance status and no chronic diarrhea were asses sed at entry to the study and after 6 months. The following assessment s were made: energy and nutrient intake based on 7-day food records, a nthropometric measurements, immunologic function as lymphocyte T-cell subpopulations (ratio of CD4 to CD8), and serum cholesterol level. Pat ients were monitored to determine clinical outcome. Intervention All p atients received standardized dietary counseling designed to address i dentified intake deficiencies and maintain body weight. Main outcome m easures Changes in energy and nutrient intake, body weight, and clinic al outcome (ie, time to AIDS-defining illness and overall survival tim e). Statistical analyses performed Group differences (HIV group vs AID S group) were sought using chi2 analyses and Student's t test. A multi variate regression model was used to determined the best predictors of clinical outcome. Results At baseline, total energy intake (based on 30 kcal/kg usual body weight) was adequate in both HIV and AIDS patien ts (101+/-4% and 103+/-5% [means+/-standard deviation] of need, respec tively). Despite dietary counseling and continued maintenance of energ y intake, body weight, serum cholesterol level, and CD4 level progress ively decreased. Consequently, saturated fat intake was found to be in versely related (P<.01) to serum cholesterol level. Clinical outcome ( after 3.5 years) was associated with baseline ratio of CD4 to CD8 (P<. 0001), weight (P<.01), and serum cholesterol level (P<.001). Multivari ate analysis related ratio of CD4 to CD8 (P<.001) and weight maintenan ce (P<.001) to favorable outcome in the final model. Applications Weig ht loss in patients with HIV infection is independently prognostic of clinical outcome, and development of hypocholesterolemia is not favora ble for clinical outcome. Because weight loss progresses despite conve ntional dietary counseling to identify energy need, interventions earl ier in the disease course should be considered along with increased ta rget levels for energy intake.