Weight Loss and Body Mass Index as Predictors of HIV Disease Progression to AIDS in Adults. Aquitaine Cohort, France, 1985–1997

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Abstract
Objective: To assess the performance of weight related nutritional markers (reported involuntary weight loss greater than 10%, measured weight loss and body mass index-BMI-) in predicting HIV disease progression. Design: Multirisk cohort of HIV-1 infected patients. Method: The three nutritional variables were studied in Cox proportional hazard models as time dependant variables. Results: The sample included 2376 subjects (median follow up: 43.1 months), of those 675 experienced an AIDS defining event. After adjustment for well known prognostic factors, the reported weight loss greater than 10% tripled the risk of progression to clinical AIDS (Hazard ratio [HR] 3.0, 95% confidence interval [CI] 2.5–3.7). For measured weight loss under 5%, between 5% and 10% and greater than 10% of baseline weight compared with no weight loss, hazard ratios were respectively 1.8 (CI 1.5–2.2), 2.6 (CI 2.1–3.2) and 5.1 (CI 4.1–6.4). The relative risks of AIDS were 1.7 (CI 1.3–2.2) for BMI between 17 kg/m2 and 18.5 kg/m2, 2.6 (CI 1.7–4.0) for BMI between 16 kg/m2 and 17 kg/m2 and 4.7 (CI 3.0–7.4) for BMI under 16 kg/m2. Comments: Even a limited weight loss measured at a given time during follow up increases the risk of HIV progression; moreover, a simple cross-sectionnal measure of BMI has a good predictive value for subsequent development of clinical disease.