title: Association between weight gain and clinical outcomes among malnourished adults initiating antiretroviral therapy in Lusaka, Zambia.
abstract: OBJECTIVE
  To describe the association between 6-month weight gain on antiretroviral therapy (ART) and subsequent clinical outcomes.
  
  
  METHODS
  A retrospective analysis of a large programmatic cohort in Lusaka, Zambia.
  
  
  METHODS
  Using Kaplan-Meier analysis and Cox proportional hazards models, we examined the association between 6-month weight gain and the risk of subsequent death and clinical treatment failure. Because it is a known effect modifier, we stratified our analysis according to body mass index (BMI).
  
  
  RESULTS
  Twenty-seven thousand nine hundred fifteen adults initiating ART were included in the analysis. Patients in the lower BMI categories demonstrated greater weight gain. In the post 6-month analysis, absolute weight loss was strongly associated with mortality across all BMI strata, with the highest risk observed among those with BMI <16 kg/m (adjusted hazard ratio 9.7; 95% CI: 4.7 to 20.0). There seemed to be an inverse relationship between weight gain and mortality among patients with BMI <16 kg/m. Similar trends were observed with clinical treatment failure.
  
  
  CONCLUSIONS
  Weight gain after ART initiation is associated with improved survival and decreased risk for clinical failure, especially in the lower BMI strata. Prospective trials to promote weight gain after ART initiation among malnourished patients in resource-constrained settings are warranted.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. john.r.koethe@vanderbilt.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Koethe
authors.forename: Anna
authors.initials: A
authors.lastname: Lukusa
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Giganti
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Nyirenda
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Limbada
authors.forename: Yolan
authors.initials: Y
authors.lastname: Banda
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015430:Weight Gain; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents