PROSPECTIVE ANALYSIS OF PATTERNS OF WEIGHT CHANGE IN STAGE-IV HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Weight loss is a major manifestation of infection with the human immun odeficiency virus (HIV). Prospective analysis of weight change was per formed in 30 male subjects with stage IV HIV infection over a period o f 9-49 mo and weight change events (> 4 kg) related to contemporaneous clinical events. Two distinct patterns of weight loss were observed: episodes of acute severe weight loss and episodes of chronic unremitti ng progressive weight loss. Thirty-three acute episodes (median 9.1 kg in 1.7 mo) and 23 chronic episodes (13.2 kg in 9.5 mo) were identifie d. Twenty-seven of 33 (82%) acute weight-loss episodes were associated with nongastrointestinal opportunistic infections and 15 of 23 (65%) chronic episodes with gastrointestinal disease (P < 0.01). Weight loss was neither inevitable nor unremitting. Periods of weight stability ( > 4 mo) occurred in 13 individuals (43%); 35 episodes of weight gain w ere identified, mostly related to recovery from opportunistic infectio n. These findings have important implications for our understanding of the natural history of weight loss in HIV infection.