Body Mass Index at diagnosis is independent predictor of survival

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.

BMI within 3 months of HIV diagnosis was obtained from 1657 patients aged >/=15 years, recruited in a seroprevalent clinical cohort in The Gambia, West Africa, since 1992 and followed up at least once.

Baseline CD4+ counts and clinical assessment at time of diagnosis were done. The mortality hazard ratio (HR) of those with a baseline BMI <18 compared with those with a baseline BMI >/=18 was 3.4.

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 >/=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.

Sensitivity and specificity of baseline BMI <18 was comparable to that of a CD4+ count <200 in predicting mortality within 6 months of diagnosis

The authors conclude: “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.”

The investigators also note that these study results have significant implications for drug treatment in developing countries. They conclude, “BMI at diagnosis is a low-technology, affordable, prognostic indicator, independent of age, sex, CD4 cell count, or HIV type.”

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van der Sande M et al. Body Mass Index at time of HIV diagnosis: a strong and independent predictor of survival. Journal of Acquired Immune Deficiency Syndromes. 37(2): 1288-1294, 1 October 2004.
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