HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy

Background. A decrease in the rate of human immunodeficiency virus (HIV) infection-related wasting has been reported in the era of highly active antiretroviral therapy (HAART). We investigated this concern in a hard-to-reach population of HIV-infected drug users in Miami, Florida. Methods. After informed consent was obtained, 119 HIV-infected drug users were administered questionnaires involving demographic, medical history, and food-security information. Blood samples were drawn for immunological and viral studies. HIV-related wasting over a period of >= 6 months was defined as a body mass index of < 18.5 kg/m(2), unintentional weight loss of >= 10% over 6 months, or a weight of < 90% of the ideal body weight. Results. The prevalence of HIV-related wasting was 17.6%. A significantly higher proportion of those who experienced wasting (81%) reported that there were periods during the previous month when they went for >= 1 day without eating (i.e., food insecurity), compared with those who did not experience wasting (57%). Although a greater percentage of patients who experienced wasting were receiving HAART, their HIV RNA levels were more than twice as high (deviation [SD], copies/mL; median log HIV RNA level mean +/- standard 166,689 +/- 238,002 +/- SD log(10) copies/mL) as those for the group that did not experience wasting (, 72,156 +/- 10.2 +/- 2.7 mean +/- SD 149,080; median log HIV RNA log(10) copies/mL). Participants who experienced wasting were level +/- SD 9.2 +/- 2.3 more likely to be heavy alcohol drinkers and users of cocaine. In multivariate analysis that included age, sex, food security, alcohol use, cocaine use, viral load, and receipt of antiretroviral therapy, the only significant predictors of wasting were >= 1 day without eating during the previous month (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.18-3.26; P - .01) and viral load (OR, 1.64; 95% CI, 1.00-2.69; P = 05). Conclusions. HIV-related wasting continues to be common among HIV- infected drug users, even among HAART recipients. Food insecurity and viral load were the only independent predictors of wasting. The social and economic conditions affecting the lifestyle of HIV-infected drug users constitute a challenge for prevention and treatment of wasting.