Body mass index at time of HIV diagnosis: A strong and independent predictor of survival

Marianne A.B. Van Der Sande, Maarten F. Shim Van Der Loeff, Akum A. Aveika, Saihou Sabally, Toyin Togun, Ramu Sarge-Njie, Abraham S. Alabi, Assan Jaye, Tumani Corrah, Hilton C. Whittle

Research output: Contribution to journalArticlepeer-review

107 Scopus citations


Background: Identification of basic prognostic indicators of HIV infection is essential before widespread antiretroviral therapy can be implemented in low-technology settings. This study assessed how well body mass index (BMI:kg/m2) predicts survival. Methods: BMI within 3 months of HIV diagnosis was obtained from 1657 patients aged ≥15 years, recruited in a seroprevalent clinical cohort in The Gambia since 1992 and followed up at least once. Baseline CD4+ counts and clinical assessment at time of diagnosis were done. Results: The mortality hazard ratio (HR) of those with a baseline BMI <18 compared with those with a baseline BMI ≥18 was 3.4 (95% CI, 3.0-3.9). The median survival time of those presenting with a BMI <16 was 0.8 years, in contrast to a median survival of 8.9 years for those with a baseline BMI ≥22. Baseline BMI <18 remained a highly significant independent predictor of mortality after adjustment for age, sex, co-trimoxazole prophylaxis, tuberculosis, reported wasting at diagnosis, and baseline CD4 + cell count (adjusted HR = 2.5, 95% CI 2.0-3.0). Sensitivity and specificity of baseline BMI <18 was comparable to that of a CD4+ count <200 in predicting mortality within 6 months of diagnosis. Discussion: BMI at diagnosis is a strong, independent predictor of survival in HIV-infected patients in West Africa. In the absence of sophisticated clinical and laboratory support, BMI may also prove a useful guide for deciding when to initiate antiretroviral therapy.

Original languageEnglish (US)
Pages (from-to)1288-1294
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Oct 1 2004
Externally publishedYes


  • Africa
  • Body mass index
  • CD4 count
  • Cohort
  • HIV-1
  • HIV-2
  • Survival

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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