Applied Nutritional InvestigationsMalnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients
Introduction
Infection by the human immunodepression virus (HIV) is characterized by progressive destruction of the immune system, which leads to recurrent opportunistic infections, progressive debilitation, and death. But malnutrition is one major complication of the HIV infection1 and has been recognized as a significant prognostic factor in advanced disease.2, 3, 4 Malnutrition is not only a result of HIV infection but also of the numerous associated complications,5 hence the wide variability in its clinical manifestations. Even if malnutrition is more frequent at the end stage of the disease, it can also occur at the onset of the chronic infection process, before immunodepression.6 Malnutrition itself is a cause of immunodepression and can worsen HIV-related immunodepression. However, loss of body weight has been reported to be relatively independent of the level of immunodepression during the course of HIV disease.4 The results presented are intended to establish the main factors associated with poor survival during HIV infection. A secondary aim of the study was to identify the factors associated with a deficient nutritional status. To clarify the relation between immunodepression and malnutrition in HIV-infected patients, the observations were extended into a long-term follow-up study.
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Patients
The study population was recruited among HIV-seropositive subjects attending one of the four outpatient clinics of Bichat-C. Bernard (BCB) Hospital. Between January 1993 and January 1995, HIV-infected outpatients from the BCB Hospital were systematically recruited into a long-term follow-up study under the supervision of the nutritional team after an initial nutritional evaluation.
Methods
HIV serodiagnosis was performed with an enzyme-linked immunosorbent assay (Diagnostic Pasteur, Marnes la coquette,
Results
One hundred sixty-five patients, without active secondary infection, were recruited and underwent the initial nutritional evaluation. Thirty-six dropped out and could not be evaluated for long-term outcome. However, all demographic data, HIV-related disease events, and nutritional status at the initial evaluation were similar across patients in the long-term follow-up and those who dropped out. Therefore, the results were calculated 129 patients. Of these 129 subjects, 95% were men. Mean age
Discussion
The present study corroborates, with a larger number of patients, the previous finding of a decreased survival rate in HIV-infected patients presenting low CD4 counts and/or advanced malnutrition. The results also validate that nutritional status remains a significant predictor of survival rate in adults with HIV after adjusting for CD4 count and history of secondary events. In the present study, we also show that the plasma level of CRP, which reflects systemic inflammation, is a predictor of
Acknowledgements
We are grateful to Dr A. Girard for her help in rewriting this manuscript and editorial assistance.
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