Anthropometric and immunological success of antiretroviral therapy and prediction of virological success in west African adults.
OBJECTIVE
The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART.


METHODS
In a cohort of 622 adults in Abidjan, Côte d'Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard.


RESULTS
After 6 months of ART, the median change in BMI was an increase of 1.0 kg/m(2) (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/ml (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who did not (increases of 1.06 kg/m(2) versus 0.99 kg/m(2), P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. All results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4.


CONCLUSIONS
In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression.
Messou
Eugène
E
Programme PAC, CI, Abidjan, Côte d'Ivoire.
Gabillard
Delphine
D
Moh
Raoul
R
Inwoley
André
A
Sorho
Souleymane
S
Eholié
Serge
S
Rouet
François
F
Seyler
Catherine
C
Danel
Christine
C
Anglaret
Xavier
X
D000328:Adult; D000886:Anthropometry; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D007560:Cote d'Ivoire; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome; D019562:Viral Load