Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris

Objective: To measure the prevalence and analyse the characteristics of malnutrition among subjects attending an AIDS outpatient clinic and a day care center, to improve the nutritional management of HIV-infected subjects. Design: Prospective cross-sectional study. Setting: AIDS clinic in a University Hospital in Paris. Subjects: 124 HIV-seropositive adults attending the clinic. Main outcome measures: Evaluation of nutritional status using anthropometry, impedancemetry, plasma albumin and pre-albumin assays. Degree of malnutrition, defined by the percentage of body weight loss (BWL), calculated by reference to the usual body weight. Results: Among the 124 subjects recruited (M:F sex ratio: 3.3, mean age: 36.3 +/- 7.2 y), 77 (62.1%, 95%Cl: 53.9-70.3) had normal nutritional status (BWL less than or equal to 5%), 16 (12.9%, 95%Cl: 7.0-18.2) moderate malnutrition (5% < BWL less than or equal to 10%), 21 (16.9%, 95%Cl: 10.3-23.5) intermediate malnutrition (10% < BWL less than or equal to 20%), and 10 (8.1%, 95%Cl: 3.3-12.9) severe malnutrition (BWL > 20%). BWL was related to the CDC class (variance analysis, P < 9 x 10(-5)) and CD4 cell count (P < 3 x 10(-5)). Malnutrition was observed even among CDC class A subjects (14.9%). BWL was also related to the body mass index (P < 3 x 10(-6)), lean body mass (P < 3 x 10(-5)), body fat (P < 7 x 10(-6)) and, as assessed by impedancemetry, body cell mass (P < 10(-5)) and the extra/intra cellular water ratio (P < 2 x 10(-4)). The decrease in lean body mass was related to the decrease in body cell mass. Conclusions: Given its high frequency, malnutrition should be prevented, detected, monitored and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.