HIV-associated
wasting can have a long-term impact on physical function and quality of life,
according to research from the United States published in the online edition of
AIDS. The research was conducted by
investigators from the Multicenter AIDS Cohort Study. HIV-positive men with a
wasting diagnosis were assessed an average of four years after their wasting
diagnosis and compared with HIV-positive and HIV-negative men without wasting.
“The degree of
impairment observed among HIV/wasting men may have significant clinical
implications,” comment the authors. “HIV-wasting had a similar effect of 10 –
20 years of aging on self-reported physical QoL [quality of life].”
HIV-wasting
syndrome was recognised early in the epidemic. Diagnostic criteria are
involuntary weight loss of over 10%, either chronic diarrhoea or weakness and
fever for over one month. Chronic weight loss and wasting are still among the
commonest manifestations of advanced HIV disease. Although the incidence of wasting has
declined marked with the introduction of effective antiretroviral therapy,
initial weight loss may not be restored even with effective HIV therapy.
Because the
long-term consequences of HIV-associated wasting are still unclear,
investigators from MACS designed a longitudinal study comparing the physical
function and physical and mental quality of life of HIV-positive wasting
survivors with HIV-positive and HIV-negative men without wasting.
The impact of
wasting on overall survival was also monitored.
Patients with
wasting were assessed at least two years after they were diagnosed with the
syndrome or other manifestations of severe weight loss (BMI below 18.5kg/m2,
sustained 10% loss in body weight, or a 1%/kg loss of body weight each year
during follow-up). Men with wasting were matched with men of a similar age who
were recruited to the cohort at approximately the same time. CD4 count and
viral load were used for matching with HIV-positive men.
Assessments of
physical function included grip strength and walking speed. Physical and mental
quality of life were assessed using accredited self-administered
questionnaires.
Median survival
was significantly lower among MACS patients with HIV-related wasting (9.1
years) compared to HIV-positive men without wasting (11.6 years).
“We found that the
occurrence of HIV-wasting by any of our tested definitions was associated with
markedly shorter survival than observed among HIV-infected men without wasting
or uninfected men,” comment the investigators.
The study
population for the assessment of the impact of wasting on physical function and
quality of life comprised 85 men with HIV and a wasting diagnosis, 249 men with HIV and
no wasting and 338 HIV-negative men.
Most of the study
visits (80%) took place after 1996 – the year in which effective HIV therapy became
widely available.
Men with wasting
were assessed a median of four years after they were diagnosed with the
syndrome. During this time, they experienced a small but significant increase
in total body weight. However, they still weighed between 8-9kg less than men
without wasting.
“We suspect that
wasting in our cohort was associated largely with losses in lean mass, with
subsequent regain largely representing fat mass,” comment the investigators.
“The persistent low body weight and mean gain of only 2kg over 4 years is of
particular concern in regards to long-term consequences in our cohort.”
At the time of
assessment, the men with wasting had more co-morbid health conditions (2 vs.1),
greater levels of use of stavudine (d4T) – an antiretroviral associated with
fat loss (69% vs. 54%; cumulative use 2 years vs 0.5 years), and greater levels
of use of therapy to counter wasting (testosterone – 38% vs. 22%).
Men with
HIV-associated wasting had lower grip strength and poorer physical quality of
life than HIV-positive men without wasting (p < 0.03), and poorer
physical quality of life but higher mental quality of life compared to
HIV-negative men (p < 0.05). Walking speed did not differ
significantly between the wasting and non-wasting patients.
When comparison
was limited to patients with HIV, the association between wasting and physical
quality of life ceased to be significant when lowest ever CD4 count and an AIDS
diagnosis were taken into account. The association between wasting and grip
strength was of borderline significance (p = 0.055), a likely reflection of the
small sample size.
“HIV-wasting has a
negative impact on muscle strength and physical QoL, years after stabilization
of body weight,” conclude the investigators. “Prior studies have demonstrated
that low body weight and/or poor strength are associated with low bone density,
injurious falls, fractures, frailty, and ultimately, could result in a loss of
independent living.”