RELATIONSHIPS AMONG NUTRITIONAL-STATUS, DISEASE PROGRESSION, AND SURVIVAL IN HIV-INFECTION

This investigation retrospectively studied relationships between survi val in human immunodeficiency virus-seropositive outpatients receiving recent therapies (n = 77) and two markers of nutritional status, seru m albumin and percent of usual body weight. Subjects were observed for an average of 186 +/- 8 days; 19% died within the study period. Kapla n-Meier curves and Cox regressions showed that older subjects who had lower CD4 counts, lower albumin levels, or had lost more weight demons trated poorer survival. Albumin levels and weight loss were related to CD4 counts. The relative risk of death for subjects with low albumin levels (<3.5 g/dl) was 3.6 times greater (p < 0.021, with 95% confiden ce limits [95%CL] of 1.2-10.9) than that for subjects with normal albu min levels (greater-than-or-equal-to 3.5 g/dl), even after controlling for age and CD4 counts. Similarly, after controlling for CD4 counts a nd age, subjects whose baseline body weights were <90% of their usual weight had a greater relative death risk (8.3 times greater, p < 0.002 , 95% CL 2.3-34.1) than those who had lost less. Survivors and nonsurv ivors who had similar CD4 counts differed significantly in albumin lev els (p < 0.05). Thus, nutritional status influences survival independe nt of CD4 counts.