LETTER
Trends in Infectious Disease and Cancer in HIV Infection
Stephen J. Seligman, MD, and
Debra Gross, RD
1 November 1996 | Volume 125 Issue 9 | Page 777
TO THE EDITOR:
Selik and colleagues [1] have called attention to the changes in infectious diseases and cancers listed on the death certificates of patients with human immunodeficiency virus (HIV) infection. The decreasing trends noted in some HIV-associated illnesses, including pneumocystosis, cryptococcosis, and candidiasis, are important and presumably reflect changes in prophylaxis and treatment. Accordingly, such data could be helpful in modifying patient care. Strikingly absent from the article by Selik and colleagues [1], however, is mention of the wasting syndrome and associated malnutrition. Unfortunately, diagnoses reflecting weight loss are frequently omitted from death certificates.
A recent case at our institution illustrates this problem. A patient with HIV infection, markedly decreased CD4 count, diminished nutrient intake, and weight loss to 61% of his ideal body weight died without obvious acute infection. The death certificate, filled out by a physician not previously associated with this patient's care, listed as a cause of death pulmonary tuberculosis, a disease for which no clinical or laboratory evidence was present.
Weight loss is a well-recognized component of late-stage HIV disease and is associated with decreased survival time [2, 3]. Loss of body weight to 66% of ideal body weight portends a poor prognosis [4, 5].
Because of the influence of malnutrition on death in HIV-infected patients, changes are needed to encourage listing of malnutrition in death certificates. This problem with death certificate data should be addressed in discussions of trends in HIV-associated mortality.
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Author and Article Information
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State University of New York Health Science Center Brooklyn, NY 11203.
1. Selik RM, Chu SY, Ward JW. Trends in infectious diseases and cancers among persons dying of HIV infection in the United States from 1987 to 1992. Ann Intern Med. 1995; 123:933-6.
2. Guenter P, Muurahainen N, Simons G, Kosok A, Cohan GR, Rudenstein R, et al. Relationships among nutritional status, disease progression, and survival in HIV infection. J Acquir Immune Defic Syndr. 1993; 6:1130-8.
3. Semba RD, Caiaffa WT, Graham NM, Cohn S, Vlahov D. Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. J Infect Dis. 1995; 171:1196-202.
4. Grunfeld C, Feingold KR. Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. N Engl J Med. 1992; 327:329-37.
5. Kotler DP, Tierney AR, Wang J, Pierson RN Jr. Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr. 1989; 50:444-7.
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