Early immunologic response and subsequent survival among malnourished adults receiving antiretroviral therapy in Urban Zambia.

Koethe JR, Limbada MI, Giganti MJ, Nyirenda CK, Mulenga L, Wester CW, Chi BH, Stringer JS
AIDS. 2010 24 (13): 2117-21

PMID: 20543657 · PMCID: PMC2919155 · DOI:10.1097/QAD.0b013e32833b784a

OBJECTIVE - To evaluate the relationship between early CD4(+) lymphocyte recovery on antiretroviral therapy (ART) and subsequent survival among low body mass index (BMI) HIV-1-infected adults.

DESIGN - Retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

METHODS - We evaluated ART-treated adults enrolled in care for more than 6 months. We stratified this study population according to World Health Organization (WHO) malnutrition criteria: normal (BMI >or=18.5 kg/m(2)), mild (17.00-18.49), moderate (16.00-16.99), and severe (<16.0). We used Cox proportional hazards regression to estimate the subsequent risk of death associated with absolute CD4(+) cell count change over the first 6 months on ART. To account for effect modification associated with baseline CD4(+) cell count, a weighted summary measure was calculated.

RESULTS - From May 2004 to February 2009, 56,612 patients initiated ART at Lusaka district clinics; of these, 33 097 (58%) were included in this analysis. The median change in 0-6 month CD4(+) cell count in each baseline BMI strata varied from 127 to 131 cells/microl. There was a statistically significant, inverse association between baseline BMI and the post 6-month hazard for mortality only among those patients with less than 100 cells/microl increase in the first 6 months of ART. A CD4(+) cell count increase of at least 100 cells/microl over the first 6 months of ART was not associated with a higher hazard for mortality, regardless of baseline BMI.

CONCLUSIONS - Low baseline BMI and attenuated CD4(+) cell count response at 6 months had a compounding, negative impact on post 6-month survival. Specific guidelines for monitoring ART response using immunologic criteria may be warranted for low BMI patients.

MeSH Terms (15)

Adolescent Adult Antiretroviral Therapy, Highly Active Body Mass Index CD4 Lymphocyte Count Female HIV-1 HIV Infections Humans Male Malnutrition Retrospective Studies Urban Health Young Adult Zambia

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