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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Estimate the number of wasting person with AIDS
Jun 14, 1999

What is the approximate percentage to be used when trying to estimate the potential number of people living with CDC-defined wasting for a specific cumulative number of people living with AIDS? Is there an estimate to be used to determine CDC-defined wasting for people living with HIV?

For example, if the greater San Francisco metropolitan area has approximately 26,000 cumulative AIDS cases for the period ending March 1999, is a 10% estimate for wasting an appropriate number -- that there are approximately 2600 person's with AIDS that are potentially wasting at any given time?

Response from Dr. Fisher

An important question. Afew years ago, before protease inhibitors,the estimate of wasting as the AIDS-defining diagnosis in HIV infection ranged from upwards of 20%. It was also essentially true that wasting (>10% involuntary weight loss, as the classic, formal definition) was nearly universal in advanced disease.

The advent of potent ARV therapy has changed things, at least superficially. Wasting, defined as weight loss, is not universal in advanced disease anymore. But PI therapy has been shown to increase almost entirely body fat, not lean tissue mass. So we have a new cadre of people without much weight loss, but nevertheless with lean tisue loss(the true measure of interest).

It is therefore difficult to estimate the true incidence of biologically significant wasting, in 1999. Criterea of weight loss are particularly inadequate. Since survival, functional performance and quality of life all correlate with lean tissue, not weight per se, there is a big gap in the current clinical definition.

If we were to assume that the incidence of lean tissue loss has not changed from pre-PI era, then I'd use at least 10-20% of AIDS patients as meeting classic criterea. And this would probably be an underestimate. Moreover, it is probably more accurate to use>5% as the cut-off, not >10%, since >5% loss is associated with poor clinical outcomes.


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