Malnutrition in patients with AIDS

Malnutrition is a frequent problem in persons infected with the human immunodeficiency virus. The origin of malnutrition in patients with AIDS may be multifactorial. The primary mechanisms include disorders of food intake, alterations in intermediary metabolism, and nutrient malabsorption. Attention to the problems of malnutrition in patients with AIDS is of paramount importance because the timing of death in these patients may be more closely related to degree of body cell mass depletion than to any specific underlying infection. Nutritional support can improve nutritional status in selected patients, and repletion of body cell mass may be associated with functional improvement. Early assessment, attention to nutritional requirements, and prompt intervention can minimize wasting and replete body cell mass. This article examines the evidence for malnutrition in patients with AIDS, reviews the studies of nutritional support, and presents an approach to the management of malnutrition in AIDS.     

Comparison of total body potassium with other techniques for measuring lean body mass in men and women with AIDS wasting

BACKGROUND: Lean body mass is an important predictor of survival and functional status in patients with AIDS wasting. The bias between different techniques for assessing body composition in AIDS wasting is not known. DESIGN: We compared total body potassium (TBK) with fat-free mass (FFM) determined by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold-thickness measurement (SKF) in 132 patients (63 men, 69 women) with AIDS wasting (weight < 90% of ideal body weight, or weight loss > 10% of original, or both). None of the subjects exhibited clinical lipodystrophy. Comparisons were made by using different BIA equations. RESULTS: Lean body mass determined by DXA was highly correlated with TBK in men (r = 0.79, P: < 0.0001) and women (r = 0.84, P: < 0.0001). FFM(BIA) and FFM(DXA) were significantly different (P: < 0.01 in men and P: < 0.0001 in women). The difference between FFM(DXA) and FFM(BIA) was significantly greater with greater weight and body fat, particularly in HIV-infected women (r = -0.39, P: = 0.001 for weight; r = -0.60, P: < 0.0001 for fat). The comparability of FFM and fat mass determined by DXA and BIA was dependent on the specific BIA equation used. Among men, no single BIA equation was more highly predictive of fat mass and FFM in comparison with DXA. CONCLUSIONS: The differences between DXA, BIA, and SKF in the determination of fat mass and FFM are significant in patients with AIDS wasting. BIA overestimates FFM compared with DXA in those with greater body fat. Standard BIA equations may not accurately estimate FFM and fat mass in men and women with AIDS wasting.     

Body composition studies in patients with wasting associated with tuberculosis

OBJECTIVE: Wasting is a well-recognized manifestation of tuberculosis (TB), but little is known about the alterations in body composition that occur. Therefore, we measured regional and whole-body composition in patients with TB and wasting. METHODS: Body composition was measured by dual-energy x-ray absorptiometry in 18 patients with newly diagnosed TB and wasting (10 coinfected with human immunodeficiency virus [HIV]) and 22 controls (10 coinfected with HIV). RESULTS: Patients with TB and wasting had significantly lower body weight (48.6 versus 62.0 kg), lean body mass (39.6 versus 45.6 kg), and fat mass (6.2 versus 12.6 kg) than did controls. Patients with TB had significantly reduced lean tissue in the limbs (15.2 versus 19.1 kg) and trunk (21.3 versus 23.2 kg) and significantly higher trunk-to-limb lean ratio (1.41 versus 1.22) compared with controls. Patients with TB had significantly reduced fat in the limbs (3.4 versus 6.1 kg) and trunk (2.1 versus 5.7 kg) and significantly lower trunk-to-limb fat ratio (0.52 versus 0.92) compared with controls. Body composition measurements were no different in patients with and without HIV coinfection. CONCLUSIONS: Wasting in TB is associated with depletion of whole-body lean and fat tissue in approximately equal proportions overall, but lean tissue depletion is greater in the limbs and fat tissue depletion is greater in the trunk. HIV coinfection does not affect the magnitude or distribution of the body composition changes.     

艾滋病人营养耗竭

Wasting is involuntary loss of bodyweight irrespective of itscomponent.Sarcopenie is involuntary loss of the most imortant compartmet of the body:the lean body mass or protein component:the organ mass and especially the muscle mass.Wasting is therefore due to an imbalance between synthesis and breakdown of protein or the other major mass:fat.An imbalance between synthesis and breakdown is either due to imbalance bwtween intake and-expenditure of energy or specific substrateo r due to a specific disturbance in synthesis and or breakdown itself.The imbalance between energy intake and expenditure is either due to a low intake or increased expenditure.In HIV infection it has been shown that total energy expenditure is not increased despite a higher resting metabolic rate due to a concomitant decrease in energy related to physical activity.An important cause of loss of body weight in HIV infection proved to be insufficient intake,as intake is rather low,even compared to healthy controls,especially in the more critically ill patients.Futile or substrate cycling,the inappropriate use of substrates and the uncoupling of enzymatic enents from energy formation,is a well known cause of involuntary loss of body weight because these processes waste energy.Substrate cycles have not been measured in AIDS.However,it is unlikely that futile ycling contributes to wasting in AIDS,because basal glucose production is normal in AIDS and the energy requirements of futile substrate cycles are low.De-novo lipogenesis is an energy wasting process of significant importance.Although de-novo lipogenesis is considerably stimulated in AIDS compared to healthy controls the absolute energy(kcal/kg/day) expended in this process is rather low,Abnormalities in glucose storage are therefore no likely cause for wasting in AIDS.Whole body protein synthesis and breakdown seem to be increased in asymptomatic HIV positive subjects and patients with AIDS-wasting to a comparable degree.These changes in itself are therefore no explanation for the characteristic sarcopenie in AIDS wasting.Although the acute anabolic response on whole body level seems to be of a similar magnitude as in healthy controls,there must be disturbances in the anabolic potential in certain areas of the body as the anabolic response of muscle protein synthesis and albumin synthesis to growth hormone is disturbed in wasting.The pathophysiological mehanism behind this feature is unknown.In conclusion:wasting in HIV infection i due to a combination of lack of food intake and specific disturbances in especially protein metabolism.     

Severe arm-muscle wasting: sign of lethal malnutrition in sick elderly men.

During a 3-yr period, I detected 29 sick men with severe muscle wasting defined by corrected arm-muscle area less than or equal to 16.9 cm2. Almost invariably, these men had weight and body mass index below the 3rd percentile. All had marked depletion of total-body muscle and protein mass, as evidenced by low urinary creatinine-height ratio and total-body nitrogen from neutron-activation analysis. Median survival was only 1.2 mo. Subjects were divided according to survival at 3 mo. The 8 survivors differed from the 21 who died in that they had higher energy intake and a greater chance of restoring muscle mass (5/8 vs. 0/21, P less than 0.001). Treatment of this lethal wasting state remains unsatisfactory. Hence, the most sensible approach is prevention.     

Rosiglitazone reduces body wasting and improves survival in a rat model of cancer cachexia

ObjectiveRosiglitazone improves insulin sensitivity and promotes weight gain in patients with type 2 diabetes mellitus, which could be useful in wasting and cachexia. However, its effects on cardiac function are controversial. The aim of this study was to investigate the effects of rosiglitazone on body wasting, body composition, cardiac function, and survival in a rat model of cancer cachexia.MethodsRats were injected with Yoshida AH-130 hepatoma tumor cells and randomized to receive placebo or rosiglitazone 4 mg/kg daily. Treatment started 1 d after tumor inoculation and the rats were sacrificed 14 d thereafter. Body weight and body composition was measured at baseline and after removal of tumor. Echocardiography was performed at baseline and on day 11. At the end of the study, organs were weighed and the proteasome activity in gastrocnemius muscle was measured.ResultsSurvival analysis showed a significant benefit from treatment with rosiglitazone (hazard ratio = 0.38, 95% confidence interval: 0.15–0.86). Rosiglitazone reduced average daily weight loss (2.33 g/d rosiglitazone versus 3.93 g/d placebo; P < 0.05) as a result of both fat and lean mass preservation. It decelerated white and brown tissue wasting, but had no effect on skeletal muscle mass and heart mass. However, peptidyl-glutamyl-protein-hydrolysing and trypsin-like activity in gastrocnemius muscle was significantly reduced by rosiglitazone. Finally, it increased left ventricular ejection fraction, fractional shortening, and systolic volume and improved cardiac output in cachectic cancer rats.ConclusionsRosiglitazone prevents weight loss and improves survival in a rat model of cancer cachexia. It exerts beneficial effects on cardiac function.     

Increased body weight and improved quality of life in AIDS patients following V-1 Immunitor administration

OBJECTIVES: Development of affordable and safe therapy to reverse the loss of body mass is of critical importance since AIDS-related wasting is associated with increased mortality. METHOD: We have demonstrated earlier that oral therapeutic HIV vaccine, V-1 Immunitor (V1), tested in a small group of AIDS patients in Thailand not only increases T-cell counts and decreases the viral load but also results in weight gain and prolonged survival. To further expand this observation, we retrospectively analyzed 650 HIV-positive patients who were followed for an average of 23 weeks. RESULTS: The treatment with V1 resulted in a sustained and statistically significant increase in body mass across the whole population (mean+/-s.e.; 1.5+/-0.4 kg; P=6.5E-015). Among them, 384 (59%) patients gained an average of 4.2+/-0.2 kg; 107 (17%) had unchanged weight; and 159 (24%) had lost 3.8+/-0.3 kg. Thus, the prevailing majority of patients (76%) were able to gain or maintain weight. Treatment was well tolerated; in a survey of health status in a comparable but separate group of 382 patients, about 85% reported subjective improvement after V1 treatment, 6% reported no difference, and 9% of the patients reported minor adverse reactions, which did not last more than 1 week. Subjective improvement coincides with the reduction or clearance of oral thrush or mucocutaneous candidiasis in 87.5% of the patients. CONCLUSIONS: In an open label setting, V1 increases body weight, subjective assessment of quality of life, and is safe and effective for HIV patients with weight loss. These data provide the impetus of using V-1 Immunitor as an affordable and easy-to-administer means of treating AIDS-associated wasting and opportunistic infections.     

Treatment of Cachexia: An Overview of Recent Developments

Body wasting in the context of chronic illness is associated with reduced quality of life and impaired survival. Recent clinical trials have investigated different approaches to improve patients’ skeletal muscle mass and strength, exercise capacity, and survival in the context of cachexia and body wasting, many of them in patients with cancer. The aim of this article was to summarize clinical trials published over the past 2 years. Therapeutic approaches discussed include appetite stimulants, such as megestrol acetate, L-carnitine, or melatonin, anti-inflammatory drugs, such as thalidomide, pentoxyphylline, or a monoclonal antibody against interleukin-1α as well as ghrelin and the ghrelin agonist anamorelin; nutritional support, and anabolics, such as enobosarm and testosterone.     

应用生物电阻抗分析法检测营养不良病人的人体组成

目的 :应用生物电阻抗分析法 ,检测营养不良病人人体组成的改变。　方法 :中等程度以上营养不良住院病人 6 8例 ,其中男 4 0例 ,女 2 8例 ,年龄为 5 3± 16 (37～ 6 8)岁作为研究对象。 78名健康志愿者 (男 4 4 ,女 34)为对照者 ,年龄为 5 2± 11(38～ 6 2 )岁。人体组成测定应用HYDRAECF/ICF 4 2 0 0多频率生物电阻抗分析仪。　结果 :营养不良病人实际平均体重是理想体重的 6 8.8% ,其体质指数、肱三头肌皮皱厚度、臂肌围、白蛋白、转铁蛋白、前白蛋白及淋巴细胞总数均明显低于正常值 ,属中、重度营养不良范围。营养不良病人的体脂、瘦组织群、体细胞群及细胞内液含量均明显低于健康志愿者 (P <0 .0 5 )。细胞外液含量比例高于健康志愿者 (5 8.5 %vs 4 8.5 % ) (P <0 .0 5 )。　结论 :营养不良时人体体脂、瘦组织群和体细胞群存在不同程度的消耗 ,机体细胞内液丢失 ,而细胞外液增加。     

Glutamine-antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial

Loss of body cell mass, the active functioning tissue of the body, commonly occurs in patients with human immunodeficiency virus (HIV) infection, and the extent of wasting is related to the length of survival. We evaluated the anabolic role of the amino acid L-glutamine (GLN) and antioxidants in a double-blind, placebo-controlled trial in 26 patients with > 5% weight loss since disease onset. Subjects received GLN-antioxidants (40 g/d) in divided doses or glycine (40 g/d) as the placebo for 12 wk. Throughout the study, the subjects were seen weekly by a nutritionist, and body weight, bioelectric impedance assessment, and nutritional counseling were performed. Twenty-one subjects completed the study, and the groups were well matched. The 5 patients excluded from analysis all met a priori exclusion criteria. Over 3 mo, the GLN-antioxidant group gained 2.2 kg in body weight (3.2%), whereas the control group gained 0.3 kg (0.4%, P = 0.04 for difference between groups). The GLN-antioxidant group gained 1.8 kg in body cell mass, whereas the control group gained 0.4 kg (P = 0.007). Intracellular water increased in the GLN-antioxidant group but not in the control group. In conclusion, GLN-antioxidant nutrient supplementation can increase body weight, body cell mass, and intracellular water when compared with placebo supplementation. GLN-antioxidant supplementation provides a highly cost-effective therapy for the rehabilitation of HIV+ patients with weight loss.     

Body composition measurements during wasting diseases

Body wasting is a common feature of severe chronic diseases. Determination of body compartments is essential in the evaluation of patients with wasting diseases in order to optimize their nutritional support. The main methods described together with their advantages and disadvantages are anthropometric measurements, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, total body water, total body potassium and in-vivo neutron activation analysis. The combination of dual-energy X-ray absorptiometry to measure bone and fat mass and bioelectrical impedance analysis to determine total body water and fat-free mass permits evaluation of body composition and periodic follow-up of body compartments in various pathologies. Total body potassium, total body water and in-vivo neutron activation analysis are research methods that elucidate the abnormal consequences of chronic pathologies on hydration status and body cell mass.     

广西99例AIDS患者经高效抗逆转录病毒治疗后脂代谢的初步研究

目的了解艾滋病（acquired immunodeficiency syndrome,AIDS）患者经高效抗逆转录病毒治疗（highly active antiretroviral therapy,HAART）后体脂肪的代谢情况。方法采用生物电阻抗法对99例经HAART治疗的AIDS患者进行体成分定量测定,用偏相关分析了解总体脂肪量与各部位脂肪量的关系,通过建立多重线性回归方程对脂肪量进行预测。结果男女患者的总脂肪量、皮下、躯干和四肢脂肪含量差异均有统计学意义（均有P〈0．05）。偏相关分析显示,AIDS患者的总脂肪量与内脏脂肪量、皮下脂肪量及右上肢脂肪量均呈正相关（均有P〈0．05）。多重线性回归分析结果显示,总脂肪量与皮下脂肪量、内脏脂肪量及体重关系密切。结论本研究获得了广西AIDS患者体脂肪的基线资料,可为开展AIDS病人脂代谢的防控等提供科学依据。     

Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances.     

Evidence and Mechanisms of Fat Depletion in Cancer

The majority of cancer patients experience wasting characterized by muscle loss with or without fat loss. In human and animal models of cancer, body composition assessment and morphological analysis reveals adipose atrophy and presence of smaller adipocytes. Fat loss is associated with reduced quality of life in cancer patients and shorter survival independent of body mass index. Fat loss occurs in both visceral and subcutaneous depots; however, the pattern of loss has been incompletely characterized. Increased lipolysis and fat oxidation, decreased lipogenesis, impaired lipid depositionand adipogenesis, as well as browning of white adipose tissue may underlie adipose atrophy in cancer. Inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1 beta (IL-1β) produced by the tumor or adipose tissue may also contribute to adipose depletion. Identifying the mechanisms and time course of fat mass changes in cancer may help identify individuals at risk of adipose depletion and define interventions to circumvent wasting. This review outlines current knowledge of fat mass in cancer and illustrates the need for further studies to assess alterations in visceral and subcutaneous adipose depots and possible mechanisms for loss of fat during cancer progression.     

Restauration de la masse maigre par l'administration de facteurs de croissance lors de la dénutrition sévère associée au VIH

Body wasting, particularly loss of lean body mass (LBM), is a frequent complication of human immunodeficiency virus (HIV) infection and has been associated with impaired quality of life, accelerated disease progression, and reduced survival. The failure of nutritional or appetite-stimulating therapies to consistently restore LBM has prompted investigation of specific protein anabolic hormones as potential therapies for HIV-associated wasting. Treatment with pharmacologic doses of recombinant human growth hormone (rhGH) resulted in weight gain and nitrogen retention in a short-term metabolic ward study. Furthermore, rhGH induced sustained increases in weight and LBM, accompanied by decreases in fat, during a 12-week placebo-controlled multicenter trial. Recombinant human insulin-like growth factor-I, which is believed to mediate the protein-anabolic effects of rhGH, improved nitrogen balance only transiently during a metabolic ward study. In placebo-controlle multicenter trial, a combination of rhIGF-I with low doses of rhGH produced an increase in LBM that was less than half of that achieved with pharmacologic doses of rhGH alone during a comparable study period. Preliminary studies of testosterone and its derivatives have demonstrated increases in weight and LBM in patients with HIV infection. At this time, in double-blind, placebo-controlled trials, only pharmacologic doses of rhGH have produced sustained increases in LBM. Future studies of the use of growth factors in patients with HIV-associated wasting should be designed not just to evaluate the best ways to use these agents, but also to determine whether clinically relevant functional benefits accompany increases in weight and/or LBM.     

Impact of Postoperative Weight Loss on Survival After Resection for Pancreatic Cancer

Background: The aim of this study was to assess the effects of postoperative body weight loss on long‐term survival after resection for pancreatic cancer. Methods: A total of 93 patients with primary pancreatic cancer underwent pancreatic resection between April 2005 and December 2011. Patient characteristics, preoperative body mass index, and changes in postoperative body weight were evaluated retrospectively and correlated with long‐term survival. Results: There was no significant association between survival and preoperative body mass index. Body weight fell by 8.4% at 2 months after surgery and by 9.0% at 4 months after surgery. Severe postoperative body weight losses, both at 2 months (P = .033) and 4 months (P = .014) after surgery, were significantly associated with poor prognosis, especially among patients with stage IA–IIA pancreatic cancer (n = 43) (P = .005 at 2 months and P < .001 at 4 months). Additionally, severe body weight loss tended to be associated with shorter survival among patients with stage IIB–III pancreatic cancer (n = 50), although the difference was not significant. Multivariate analysis revealed that postoperative body weight loss was an independent prognostic factor. Conclusions: The results of this study demonstrated that pancreatic cancer patients with severe postoperative body weight loss have poorer postoperative outcomes.     

Resting energy expenditure is increased in stable, malnourished HIV-infected patients

Resting energy expenditure (REE) was measured by reference to body composition in 50 malnourished patients with human immunodeficiency virus (HIV) infection and compared with that of 14 healthy subjects. Among HIV patients, 40 had acquired immune deficiency syndrome (AIDS) and 10 had AIDS-related complex (ARC). All were in stable condition and had a previous history of progressive wasting, ie, a mean body weight loss of 14.2 +/- 8.1 kg over 16.6 mo (range 2-49 ms). The mean REE was 14% higher than estimated basal energy expenditure (EBEE), according to the Harris and Benedict formula. Thirty-four patients (68%) were classified as hypermetabolic (REE greater than 110% EBEE). The best predictable variable for REE was fat-free mass (FFM), as determined by an anthropometric method (r = 0.72; P less than 0.001). The mean REE was 12% higher in HIV patients than in the control group FFM (156 +/- 19 vs 124 +/- 17 kJ.kg FFM-1.d-1). We concluded that in stable and malnourished HIV patients, the progressive wasting may be partly related to an increase in REE. The mechanism of this hypermetabolic state remains to be established.     

Skeletal muscle mass abnormalities are associated with survival rates of institutionalized elderly nursing home residents

Background

Knowledge about the changes in skeletal muscle mass in nursing home residents is very limited. We hypothesized that such patients have different types of skeletal muscle mass abnormalities that may affect mortality rates. Therefore, the objective of this study was to evaluate the prevalence and extent of skeletal muscle mass decline, its different clinical phenotypes (sarcopenia, wasting/atrophy and cachexia) and the mortality rates associated with these abnormalities.

Methods

A retrospective chart-review study comprising 109 institutionalized nursing home residents. Body mass index, body fat mass, fat free mass, skeletal muscle mass and survival rates were assessed.

Results

Skeletal muscle mass abnormalities were found among 73 out of 109 (67.0%) patients and were more prevalent in males compared with females (97.8% and 43.8%, respectively, p<0.001). Most of these patients had muscle wasting/atrophy (51.4%) or sarcopenia (40.3%), and 9.7% suffered from cachexia. One third of the patients with abnorrmal skeletal muscle mass showed a moderate decline of skeletal muscle mass (34.7%) while the remainder (65.3%) had very low levels of skeletal muscle mass. Each group was characterized by typical medical conditions associated with skeletal muscle mass abnormality. A Kaplan-Meier survival plot of mortality showed only lower one-year survival rates in the group with sarcopenia (60%) and muscle atrophy or cachexia (53%), compared with elderly participants with a normal skeletal muscle mass (73%), (p<0.0001). There were no significant differences in 1-year mortality rates between patients with abnormal skeletal muscle mass (whether sarcopenia, cachexia or wasting).

Conclusion

About two thirds of nursing home patients show skeletal muscle mass abnormalities, most within the range of very low skeletal muscle mass rather than moderately low skeletal muscle mass, that are associated with shorter survival rates, compared with normal skeletal muscle mass patients.     

Effects of refeeding by cyclic enteral nutrition on body composition: comparative study of elderly and younger patients

Previous reports suggest that correcting the malnourished state may be more difficult in elderly people than in younger people. The aim of this study was to evaluate the effect of 21 days of cyclic enteral nutrition (CyEN) on nutritional and body composition parameters in elderly, compared with younger patients. Twenty-four patients younger than 65 years (mean age 50 years) and 26 patients 65 years of age and older (mean age 75 years) referred for refeeding, having lost at least 20% of their body weight or at least 10% in 3 months, were studied. All patients were ambulatory. Cyclic enteral nutrition was administered nocturnally via a nasogastric tube; in the daytime patients were allowed to eat normally and to walk. Resting energy expenditure was measured at day 0 by indirect calorimetry. Ten anthropometric and biological nutritional parameters and a global nutritional deficiency (GND) were measured at day 0 and 21. Body composition was measured at day 0 and 21 by bioelectric impedance analysis. Total energy intakes were 286% and 280% of resting energy expenditure in groups 1 and 2, respectively. Body weight, serum prealbumin, serum transferrin, 24 h urinary creatinine, and the GND (39.9% vs 23.3%; P < 0.01) improved significantly more in younger than in elderly patients. Fat free mass (3.9 vs 2.4 kg; P < 0.05) and body cell mass (2.7 vs 1.6 kg; P < 0.01) but not fat mass improved significantly more in younger than in elderly patients. In conclusion, 21 days refeeding by cyclic enteral nutrition with similar energy amounts is less effective to correct malnutrition in elderly than in younger patients.     

Anthropometric indices as predictors of survival in AIDS adults. Aquitaine Cohort,France, 1985–1997

The aim of the study was to assess the performance of weight related nutritional markers [reported involuntary weight loss (WL) greater than 10%, measured WL and body mass index (BMI)] in predicting survival at AIDS stage. The three anthropometric indices were used as time dependant variables in Cox models to predict survival at AIDS stage. The studied sample included 630 HIV1-infected individuals of a prospective cohort of those 421 died (median survival at AIDS stage: 19.9 months). After adjustment for usual prognostic factors of survival, the reported WL greater than 10% was a pejorative predictor of survival (hazard ratio (HR) 2.4; 95% confidence interval (CI): 1.9–3.0). For measured WL <5%, between 5 and 10% and 10% of baseline weight compared with no WL, HR were respectively, 1.9 (CI: 1.4–2.6), 3.3 (CI: 2.4–4.4) and 6.7 (CI: 5.2–8.6). The HR of death were 2.2 (CI: 1.6–3.0) for BMI between 16 and 18.4 kg/m²and 4.4 (CI: 3.1–6.3) for BMI <16 compared to normal BMI (18.5). Even a limited WL measured at a given point in time during follow up increases the risk of death at the AIDS stage. Simple cross-sectional measures of BMI have a good predictive value of survival.