Weight and body composition in a cohort of HIV-positive men and women

Objective. At issue is whether weight loss in HIV infection is a cachectic process, characterised by loss of lean body mass with conservation of fat, or a process of starvation. We present data on body composition from 516 persons at different stages of HIV infection as determined by CD4 counts. Design: Cross-sectional analyses of body composition in relation to CD4 count. Setting: The baseline data from a prospective cohort study of outcomes in HIV/AIDS in relation to nutritional status in Boston, Massachusetts, USA. Subjects: The first 516 subjects with HIV/AIDS to enrol in the study. Results: Differences in weight in relation to CD4 counts were present only at CD4 counts of 600 or less (slope below CD4 = 600: 1.9 kg per 100 CD4 cells, P < 0.0001). On average, 68% of the difference in weight over CD4 counts was fat (slope: 1.3 kg fat per 100 CD4 cells, P < 0.0001). Conclusions: This cross-sectional analysis suggests that weight loss consists principally of fat loss in those persons with adequate fat stores. This observation will need to be confirmed in longitudinal analyses.