Rt. Chlebowski et al., DIETARY-INTAKE AND COUNSELING, WEIGHT MAINTENANCE, AND THE COURSE OF HIV-INFECTION, Journal of the American Dietetic Association, 95(4), 1995, pp. 428
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.