April 4, 2001
From the early days of the epidemic, weight loss and wasting have been recognized as important elements of the HIV-related disease syndrome. Even before HIV-related wasting was recognized, medical professionals in Africa described the condition as "slim" disease. In the general US population, however, the most common weight disturbance is overweight. The prevalence of overweight tends to be higher among groups hardest hit by the HIV epidemic- indigent members of ethnic minority groups. Because little information exists on the topic, the authors undertook an investigation of the prevalence and predictive value of overweight in an inner-city HIV outpatient clinic.
One investigator reviewed the records of all patients who enrolled during 1996 at the Jacobi Medical Center HIV Clinic, a comprehensive facility whose patients come primarily from communities in the Bronx, New York City. The year 1996 was selected since it marked the end of the era before highly active antiretroviral therapy, which is associated with weight gain and fat redistribution syndromes. Prevalence of overweight was determined by calculating body mass index (BMI) at enrollment. The subsequent clinical course of the overweight group was compared with that of a randomly selected group of gender- stratified non-overweight patients.
Included in the analysis were 189 patients. Forty-one patients (21.7 percent) were overweight; 20 patients (10.6 percent) were severely overweight; and 20 patients (10.6 percent) were underweight. Women were more likely than men to be overweight, and overweight was three times more common in women than underweight.
"Providers were more likely to properly acknowledge underweight than overweight. Among patients without AIDS, there was a trend toward slower disease progression and lower viral load in overweight patients, despite similar baseline CD4+ lymphocyte counts and similar time to initiation of highly active antiretroviral therapy. In multivariate proportional hazards analyses, lower baseline BMI and falling BMI during follow-up were independently predictive of progression toward AIDS," the authors wrote.
"The medical community continues to address the serious problem of HIV-associated wasting; however, the more common disturbance of overweight has been largely ignored," they wrote. "Although the poor prognosis associated with weight loss has been the object of much investigation, the corollary of this observation, that patients who maintain or gain weight have better prognoses, has received little attention. It is possible that overweight does not merely signify the absence of significant weight loss, but that increased body mass may confer some advantage in HIV infection. . . . Our data suggest that among patients without CDC-defined AIDS at baseline, overweight patients may have had a less rapidly progressive course than non-overweight patients. Our findings should also dispel any existing myth that HIV infection is a disease confined to underweight individuals."