Long-term impact of HIV wasting on physical function in the Multicenter AIDS Cohort Study

Abstract

Background The long-term consequences of wasting among HIV-infected persons are not known. Design HIV-infected participants surviving ≥2 years based on Kaplan Meier analysis after a clinical diagnosis or weight trajectory consistent with wasting and with available physical function assessment data (grip strength, gait speed, and quality of life [QoL]) were matched to HIV-infected and -uninfected men without wasting. Methods Matching criteria at the functional assessment included age, calendar year, and CD4 cell count and plasma HIV-1 RNA (HIV-infected only). Multivariable linear regression analyses adjusted for age, cohort, race, hepatitis C status, and number of comorbid illnesses were used to assess the impact of wasting on subsequent physical function. Results Among 85 HIV-infected men surviving ≥2 years after wasting, we evaluated physical function outcomes compared to 249 HIV-infected and 338 HIV-uninfected men with no historical wasting. In multivariable regression models, HIV-infected men with prior wasting had lower grip strength and poorer physical QoL than HIV-infected men with no wasting (p≤0.03), and poorer physical QoL but higher mental QoL than HIV-uninfected men (p≤0.05). When controlling for measures of immune suppression (nadir CD4/AIDS, the association between wasting and physical QoL was markedly attenuated, whereas there was minimal impact on the association between wasting and grip strength. Conclusions HIV-infected wasting survivors had weaker grip strength compared to HIV-infected persons without wasting; immune suppression was associated only with physical QoL. HIV-infected survivors of wasting may represent a population of adults at increased risk for physical function decline.

Disease drivers of aging

“…With the advent of effective ART, these weight changes could be partially reversed; however, the impact of HIV and ART on muscle and fat was far from over. Men with a history of wasting gained less weight over time and remained an average of nearly 10 kg less than men without a history of wasting . Importantly, this low muscle mass has been associated with increased mortality .…”

Long-term body composition changes in antiretroviral-treated HIV-infected individuals

“…Changes in body composition such as central fat accumulation and loss of muscle mass may impact physical function and mortality [1, 2]. Frailty has been reported to be approximately 4-fold more common in HIV-infected individuals than in HIV-uninfected controls [3, 4], with associations seen between frailty and both sarcopenia and central obesity [5, 6]…”

‘Let Food Be Your Medicine’: a model for HIV nutrition services

“…The criteria for diagnosis of HIV-associated wasting syndrome include profound weight loss greater than 10%, plus either chronic diarrhoea or chronic weakness and fever, for more than a month [1,7]. Wasting has been associated with increased mortality, accelerated disease progression, loss of lean body mass and deterioration in strength [1,2,4,5].…”

“…The criteria for diagnosis of HIV-associated wasting syndrome include profound weight loss greater than 10%, plus either chronic diarrhoea or chronic weakness and fever, for more than a month [1,7]. Wasting has been associated with increased mortality, accelerated disease progression, loss of lean body mass and deterioration in strength [1,2,4,5]. Despite suggestions that highly active antiretroviral therapy (HAART) would reduce the occurrence of HIV associated weight loss and wasting, they remain common complications and weight loss remains an independent predictor of mortality [3,6,8].…”

“…The wasting associated with human immunodeficiency virus (HIV) is a significant clinical problem and one of the most common manifestations of advanced HIV disease [1][2][3][4][5][6]. The criteria for diagnosis of HIV-associated wasting syndrome include profound weight loss greater than 10%, plus either chronic diarrhoea or chronic weakness and fever, for more than a month [1,7].…”