AIDS Wasting Syndrome Is Declining in US

Fewer patients with HIV infection are being diagnosed with AIDS-wasting syndrome in the U.S., according to data from a large and demographically diverse cohort of 46,678 HIV-infected patients being followed by the Centers for Disease Control and Prevention.

The incidence of wasting syndrome fell from 30.2 cases per 1,000 person-years in the first half of 1992 to 11.9 cases per 1,000 person-years in the first half of 1999. "This trend was especially pronounced after the introduction of HAART in late 1995," researchers note in the July 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

Survival after a diagnosis of wasting syndrome improved during the later 1990s. "This may be another of the many benefits we have been seeing as treatment against HIV has become more effective," lead author Dr. Mark S. Dworkin of the Illinois Department of Public Health in Chicago told Reuters Health.

A CD4+ count of 200 cells per microliter or greater around the time of diagnosis of AIDS-wasting syndrome and combination antiretroviral therapy at or after the diagnosis were significantly associated with improved survival.

Treatment with the endocrinologic oxandrolone also appeared to improve survival but this result did not reach statistical significance, Dr. Dworkin said. "Our study was observational, not a controlled clinical trial, so this finding should be interpreted cautiously and confirmed by other studies," he pointed out. Treatment with testosterone, growth hormone, and megestrol acetate had no apparent impact on survival.

Stressing the importance of early diagnosis of HIV infection, he noted that it can provide "an opportunity to prescribe antiretroviral treatment and hopefully delay or prevent the onset of wasting syndrome, which is associated with many complications such as a higher risk for infections and death."

07/25/03

J Acquir Immune Defic Syndr 2003; 33:267-273.