Difficulty Swallowing and Lack of Receipt of Highly Active Antiretroviral Therapy Predict Acute Weight Loss in Human Immunodeficiency Virus Disease

Abstract

In human immunodeficiency virus (HIV) disease, symptoms of underlying illness may promote weight loss through decreased caloric intake, increased metabolic needs, or nutrient malabsorption. We evaluated disease symptoms as predictors of acute weight loss (i.e., loss of > or =5% of weight). HIV-infected men and women (n=415) were telephoned every 5 weeks to obtain information about weight and recent symptoms. Weight change between each pair of consecutive calls (telephone intervals, 2814) was calculated. Acute weight loss occurred across 4.5% of intervals and among 24% of individuals. Patients reported > or =1 symptom before 58% of telephone intervals. The most common symptoms or symptom complexes before intervals were diarrhea (21% of patients), anorexia (17%), upper respiratory symptoms (16%), skin symptoms (12%), and abdominal pain (12%). Trouble swallowing (6%) and oral symptoms (7%) were less common. Risk of acute weight loss was significantly increased when oral symptoms or trouble swallowing were present, and it was decreased when highly active antiretroviral therapy (HAART) was used or when diarrhea was not present. Even when HAART is being administered, clinicians should remain vigilant regarding weight loss, oral symptoms, and trouble swallowing.

Vitamin supplements, socioeconomic status, and morbidity events as predictors of wasting in HIV-infected women from Tanzania

“…with the findings of studies that were conducted in England (15) and in the United States (16,41), we found that events that interfere with nutrient intake (ie, oral ulcers, thrush, and vomiting) or absorption (ie, diarrhea) were significant risk factors for wasting when measured as a first episode of a low MUAC or BMI. In addition, we found that episodes of weight loss were more frequently accompanied by morbidity events than were episodes with no weight loss.…”

Predictors of early death in a cohort of Ethiopian patients treated with HAART

“…In one study, about a third of the patients treated with HAART had weight loss, as is in our patients, and it remained the most important prognostic marker [ 24 ]. Poor nutritional intake, metabolic disturbances because of drugs, and infectious conditions such as tuberculosis could be possible contributing reasons [ 27 ].…”

Declines in dietary macronutrient intake in persons with HIV infection who develop depression

“…The severity of weight loss has diminished compared with the pre-HAART era, but the incidence of weight loss has not [1][2][3] . The causes of persisting weight loss and malnutrition in HIV-infected individuals are multifactorial, with decreased energy intake due to anorexia and nausea related to HIV-associated illness or medications, increased energy demands related to chronic infection, HAART use, trouble swallowing/other oral problems and malabsorption/other gastrointestinal disorders all playing a role [4][5][6][7][8][9] .…”