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Quantitative Assessment of Cross-Sectional Muscle Area, Functional Status, and Muscle Strength in Men with the Acquired Immunodeficiency Syndrome Wasting Syndrome¹

Neuroendocrine Unit (S.G., C.C., T.S., A.K.), Infectious Disease Unit (S.D., N.B.), and Radiology (D.R., M.T.) and Physical Therapy Departments (K.P., M.C.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and the Radiology Department, Boston Veterans Affairs Medical Center and Boston University School of Medicine (B.B.), Boston, Massachusetts 02130

Address all correspondence and requests for reprints to: Steven Grinspoon, M.D., Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital, Boston, Massachusetts 02114.

The acquired immunodeficiency syndrome wasting syndrome (AWS) in men is characterized by the loss of lean body mass out of proportion to weight. Although the wasting syndrome has been thought to contribute to reduced functional capacity, the relationships among lean body mass, muscle size, functional status, and regional muscle strength have not previously been investigated in this population. In this study, 24 eugonadal men with the AWS (weight <90% of the ideal body weight or weight loss >10% from preillness maximum) underwent determination of body composition by dual energy x-ray absorptiometry (DXA), ⁴⁰K isotope analysis, urinary creatinine excretion, and quantitative computed tomographic analysis of cross-sectional muscle areas of the midarm and thigh. Overall exercise functional capacity was evaluated using the 6-min walk test, and performance of upper and lower extremities was determined with the quantitative muscle function test. Subjects were 37 ± 1 yr of age and weighed 95.5 ± 3.0% of ideal body weight, with a body mass index of 21.9 ± 0.7 kg/m² and an average weight loss of 15 ± 1%. The mean CD4 count among the subjects was 354 ± 70 cells/mm³, and viral load was 58,561 ± 32,205 copies. Sixty-two percent of subjects were receiving protease inhibitor therapy. The subjects demonstrated 90% of the expected muscle mass by the creatinine height index method. Overall performance status on the Karnofsky scale was highly correlated to weight (r = 0.51; P = 0.018; by body mass index), lean body mass (r = 0.46; P = 0.036; by DXA), and body cell mass (r = 0.47; P = 0.037; by ⁴⁰K isotope analysis). Cross-sectional muscle area of the upper extremity was the best predictor (P < 0.001) of Karnofsky score, accounting for 52% of the variability in a stepwise regression analysis. Upper body muscle strength was most significantly predicted by lean body mass (by DXA; r² = 0.78; P < 0.0001), whereas lower body strength and performance on the 6-min walk test were best predicted by lower extremity cross-sectional muscle area (r² = 0.70; P < 0.0001 and r² = 0.26; P = 0.030, respectively). These data demonstrate that cross-sectional muscle area is highly predictive of functional status and muscle strength in men with the AWS.

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