Graham N M, Muñoz A, Bacellar H, Kingsley L A, Visscher B R, Phair J P
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD.
Am J Epidemiol. 1993 Feb 15;137(4):439-46. doi: 10.1093/oxfordjournals.aje.a116692.
The relation between a number of potential risk factors and change in body mass index per semester was examined in a community-based cohort of 1,809 homosexual and bisexual men seropositive for human immunodeficiency virus type 1 (HIV-1). The men were followed semiannually for up to 6.5 years between 1984 and 1990. A total of 9,735 person-semesters of observations were available for analysis. A Markov-type autoregressive model, adjusting for previous body mass index, was used to predict the change in body mass index over each person-semester. Overall, the cohort was gaining weight. An asymptomatic participant 1.8 m in height whose CD4+ cell count was > 750/microliters gained a mean of 0.5 kg each person-semester. In bivariate autoregressive models, diarrhea, fever, oral thrush, acquired immunodeficiency syndrome (AIDS), and CD4+ lymphocyte counts of < 100 and 100-199 cells/microliters were all associated with a significant decrease in body mass index. A significant inverse association was also found between change in body mass index and lymphadenopathy and herpes zoster, but when the intercept coefficient was added, no overall decrease in body mass index was seen in these models. In a final multivariate model, diarrhea was less strongly associated with a change in body mass index (p = 0.057), although AIDS (p = 0.009), fever (p = 0.006), thrush (p = 0.002), and a CD4+ lymphocyte count of < 100 cells/microliters (p < 0.001) all remained independently associated with a decrease in body mass index. Lymphadenopathy and a CD4+ lymphocyte count of 100-199 cells/microliters were also significant covariates in the final model, but neither of the beta coefficients exceeded that of the intercept, indicating that they were not independently associated with a decrease in body mass index. These findings suggest that the importance of diarrhea as a cause of HIV-related weight loss may have been over-estimated in previous clinic-based studies. AIDS and nonspecific markers of progression (fever, thrush, and a CD4+ count of < 100 cells/microliters) were the best predictors of weight loss during a semester.
在一个以社区为基础的队列研究中，对1809名感染了1型人类免疫缺陷病毒（HIV-1）的同性恋和双性恋男性进行了研究，探讨了一些潜在风险因素与每学期体重指数变化之间的关系。这些男性在1984年至1990年间每半年随访一次，最长随访6.5年。总共9735人-学期的观察数据可用于分析。使用一种马尔可夫型自回归模型，并对先前的体重指数进行调整，以预测每个人-学期体重指数的变化。总体而言，该队列人群体重在增加。一名身高1.8米、CD4 + 细胞计数>750/微升且无症状的参与者，每人-学期平均体重增加0.5千克。在双变量自回归模型中，腹泻、发热、口腔念珠菌病、获得性免疫缺陷综合征（AIDS）以及CD4 + 淋巴细胞计数<100和100 - 199个/微升均与体重指数显著下降相关。体重指数变化与淋巴结病和带状疱疹之间也存在显著的负相关，但加入截距系数后，这些模型中体重指数并未出现总体下降。在最终的多变量模型中，腹泻与体重指数变化的关联较弱（p = 0.057），尽管AIDS（p = 0.009）、发热（p = 0.006）、鹅口疮（p = 0.002）以及CD4 + 淋巴细胞计数<100个/微升（p < 0.001）均仍独立与体重指数下降相关。淋巴结病和CD4 + 淋巴细胞计数100 - 199个/微升在最终模型中也是显著的协变量，但两个β系数均未超过截距系数，表明它们并非独立与体重指数下降相关。这些发现表明既往基于临床的研究中可能高估了腹泻作为HIV相关体重减轻原因的重要性。AIDS以及疾病进展的非特异性标志物（发热、鹅口疮和CD4 + 计数<100个/微升）是一学期内体重减轻的最佳预测指标。
