Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa.

Koethe JR, Blevins M, Bosire C, Nyirenda C, Kabagambe EK, Mwango A, Kasongo W, Zulu I, Shepherd BE, Heimburger DC
Public Health Nutr. 2013 16 (3): 549-58

PMID: 22691872 · PMCID: PMC3772135 · DOI:10.1017/S1368980012002960

OBJECTIVE - Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.

DESIGN - A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.

SETTING - A public-sector HIV clinic in Lusaka, Zambia.

SUBJECTS - One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.

RESULTS - Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18%) died before 12 weeks and another thirty-three (23%) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16% reduction in the hazard of death (adjusted hazard ratio = 0.84; P = 0.01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.

CONCLUSIONS - Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.

MeSH Terms (23)

Adult Ambulatory Care Facilities Anti-HIV Agents Antiretroviral Therapy, Highly Active Appetite Body Mass Index CD4 Lymphocyte Count Culture Diet Energy Intake Female HIV Infections Humans Hunger Male Malnutrition Observation Prospective Studies Risk Factors Self Report Survivors Treatment Outcome Zambia

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