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Trends in Infectious Disease and Cancer in HIV Infection
- Stephen J. Seligman, MD; and
- Debra Gross, RD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
