Journal Article

Changes in the Incidence and Predictors of Wasting Syndrome Related to Human Immunodeficiency Virus Infection, 1987–1999

Ellen Smit, Richard L. Skolasky, Adrian S. Dobs, Bridget C. Calhoun, Barbara R. Visscher, Frank J. Palella and Lisa P. Jacobson

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 156, issue 3, pages 211-218
Published in print August 2002 | ISSN: 0002-9262
Published online August 2002 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwf039
Changes in the Incidence and Predictors of Wasting Syndrome Related to Human Immunodeficiency Virus Infection, 1987–1999

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The authors examined the impact of potent antiretroviral therapy (ART) on the diagnosis of wasting syndrome in the Multicenter AIDS Cohort Study. Study time was divided into the periods 1988–1990, 1991–1993, 1994–1995, and 1996–1999 to correspond to different treatment eras. The proportion of acquired immunodeficiency syndrome diagnoses in which wasting was present increased from 5% in 1988–1990 to 7.1% in 1991–1993, 7.7% in 1994–1995, and 18.9% in 1996–1999. The incidence of wasting per 1,000 person-years increased from 7.5 in 1988–1990 to 14.4 in 1991–1993 and 22.1 in 1994–1995; it decreased to 13.4 in 1996–1999. Fewer patients with wasting had low hemoglobin and hematocrit levels and reported oral thrush in 1996–1999 than in any other period. Analysis of change in body mass index (weight (kg)/height (m)2) after wasting showed a faster return to prewasting levels in 1994–1995 and 1996–1999 than in earlier periods. Case-control analysis showed that wasting prior to 1996 was weakly associated with fatigue (p = 0.10), low hemoglobin (p = 0.11), and CD4-positive T-lymphocyte count (p = 0.04). During 1996–1999, wasting was weakly associated with diarrhea (p = 0.05) and potent ART (p = 0.097). Predictors of wasting have changed with potent ART. Further research is needed to determine whether lipodystrophy may be misdiagnosed as wasting syndrome. Am J Epidemiol 2002;156:211–18.

Keywords: acquired immunodeficiency syndrome; AIDS-related opportunistic infections; anti-HIV agents; body mass index; disease progression; HIV; HIV protease inhibitors; HIV wasting syndrome; Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; HIV, human immunodeficiency virus; NRTI, nucleoside reverse transcriptase inhibitor.

Journal Article.  4959 words.  Illustrated.

Subjects: Public Health and Epidemiology

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