title: Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study.
abstract: BACKGROUND
  Among people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure.
  
  
  METHODS
  We present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m² enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.
  
  
  RESULTS
  Overall, 1340 of 8685 (15.4%) HIV-positive adults were enrolled in the nutrition programme. At admission, median body mass index was 15.8 kg/m² (IQR 14.9-16.4) and 12% received combination antiretroviral therapy (ART). After a median of four months of follow up (IQR 2.2-6.1), 524 of 1106 (47.4%) patients were considered cured. An overall total of 531 of 1106 (48.0%) patients failed nutrition therapy, 132 (11.9%) of whom died and 250 (22.6%) defaulted from care. Men (OR = 1.5, 95% CI 1.2-2.0), patients with severe malnutrition at nutrition programme enrolment (OR = 2.2, 95% CI 1.7-2.8), and those never started on ART (OR = 4.5, 95% CI 2.7-7.7 for those eligible; OR = 1.6, 95% CI 1.0-2.5 for those ineligible for ART at enrolment) were at increased risk of nutrition programme failure. Diagnosed tuberculosis at nutrition programme admission or during follow up, and presence of diarrhoeal disease or extensive candidiasis at admission, were unrelated to nutrition programme failure.
  
  
  CONCLUSIONS
  Concomitant administration of ART and ready-to-use therapeutic food increases the chances of nutritional recovery in these high-risk patients. While adequate nutrition is necessary to treat malnourished HIV patients, development of improved strategies for the management of severely malnourished patients with HIV/AIDS are urgently needed.
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France. laurence_ahoua@yahoo.fr
authors.forename: Laurence
authors.initials: L
authors.lastname: Ahoua
authors.forename: Chantal
authors.initials: C
authors.lastname: Umutoni
authors.forename: Helena
authors.initials: H
authors.lastname: Huerga
authors.forename: Andrea
authors.initials: A
authors.lastname: Minetti
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Szumilin
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: David M
authors.initials: DM
authors.lastname: Olson
authors.forename: Sarala
authors.initials: S
authors.lastname: Nicholas
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D003131:Combined Modality Therapy; D005260:Female; D015658:HIV Infections / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents