Weight loss in HIV-1 infection is associated with immune activation.

OBJECTIVE

To assess the risk of developing weight loss, a decline in CD4+ T-cell count and AIDS-defining infections using urinary neopterin levels and CD4+ T-cell count.

DESIGN

Retrospective record review.

SETTING

A primary care clinic for patients at any stage of HIV infection at the University Hospital in Innsbruck, Austria, to which all patients with HIV-related diseases from the Austrian Tyrol are referred.

PATIENTS, PARTICIPANTS: Seventy-nine out of the 311 HIV-seropositive individuals attending our clinic between July 1985 and December 1991 participated in the study. The selection was made after complete examination (clinical and laboratory) and follow-up of at least 6 months, up to 48 months (median, 28 months). Patients with severe diarrhoea were excluded.

MAIN OUTCOME MEASURES

Correlation between body mass index, urinary neopterin and CD4+ T-cell count; development of AIDS-defining infections, weight loss, and a decline in CD4+ T-cells. Weight loss was recognized if > 10% of body weight, and there had been no concomitant AIDS-defining infection for at least 2 months.

RESULTS

Initial urinary neopterin (P = 0.04), but not initial CD4+ T-cell count (P = 0.94), correlated with the body mass index obtained at the end of follow-up. Using the product-limit method, urinary neopterin predicted weight loss (P < 0.0001), decline in CD4+ T-cell count to < 200 x 10(6)/l (P = 0.006) and AIDS-defining infections (P = 0.009). CD4+ T-cell count was a better predictor of AIDS-defining infections (P < 0.0001) than of weight loss (P = 0.002). Results were confirmed by multivariate analysis.

CONCLUSIONS

Weight loss > 10% of body weight is associated with immune activation.