Body mass index at time of HIV diagnosis: a strong and independent predictor of survival

Marianne A B van der Sande, Maarten F Schim van der Loeff, Akum A Aveika, Saihou Sabally, Toyin Togun, Ramu Sarge-Njie, Abraham S Alabi, Assan Jaye, Tumani Corrah, Hilton C Whittle

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Identification of basic prognostic indicators of HIV infection is essential before widespread antiretroviral therapy can be implemented in low-technology settings. This study assessed how well body mass index (BMI:kg/m2) predicts survival.

METHODS: BMI within 3 months of HIV diagnosis was obtained from 1657 patients aged > or = 15 years, recruited in a seroprevalent clinical cohort in The Gambia since 1992 and followed up at least once. Baseline CD4+ counts and clinical assessment at time of diagnosis were done.

RESULTS: The mortality hazard ratio (HR) of those with a baseline BMI <18 compared with those with a baseline BMI > or = 18 was 3.4 (95% CI, 3.0-3.9). The median survival time of those presenting with a BMI <16 was 0.8 years, in contrast to a median survival of 8.9 years for those with a baseline BMI > or = 22. Baseline BMI <18 remained a highly significant independent predictor of mortality after adjustment for age, sex, co-trimoxazole prophylaxis, tuberculosis, reported wasting at diagnosis, and baseline CD4+ cell count (adjusted HR = 2.5, 95% CI 2.0-3.0). Sensitivity and specificity of baseline BMI <18 was comparable to that of a CD4+ count <200 in predicting mortality within 6 months of diagnosis.

DISCUSSION: BMI at diagnosis is a strong, independent predictor of survival in HIV-infected patients in West Africa. In the absence of sophisticated clinical and laboratory support, BMI may also prove a useful guide for deciding when to initiate antiretroviral therapy.

Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
Volume37
Issue number2
Pages (from-to)1288-94
Number of pages7
ISSN1525-4135
DOIs
Publication statusPublished - 2004

Keywords

  • Adolescent
  • Adult
  • Aged
  • Body Mass Index
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • HIV Infections/blood
  • HIV Seropositivity/immunology
  • HIV-1
  • HIV-2
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Survival Analysis

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