title: Predictive value of weight loss on mortality of HIV-positive mothers in a prolonged breastfeeding setting.
abstract: HIV-positive lactating women may be at high risk of weight loss due to increased caloric requirements and postpartum physiological weight loss. Ten percent weight loss is associated with a higher risk of mortality in HIV-positive patients and this alone is a criterion for highly active antiretroviral therapy (HAART) initiation where CD4 counts are not available. However, no study has investigated this association in lactating postpartum women. We investigated whether 10% weight loss predicts death in postpartum HIV-positive women. A total of 9207 HIV-negative and 4495 HIV-positive mothers were recruited at delivery. Women were weighed at 6 weeks, 3 months, and every 3 months thereafter for up to 24 months postpartum and data on mortality up to 2 years were collected. The median duration of breastfeeding was longer than 18 months. Among HIV-positive women, the independent predictors of ≥10% weight loss were CD4 cell count, body mass index, and household income. Mortality was up to 7.12 (95% CI 3.47-14.61) times higher in HIV-positive women with ≥10% weight loss than those without weight loss. Ten percent weight loss in postpartum lactating HIV-positive women was significantly predictive of death. Our findings suggest that 10% weight loss is an appropriate criterion for HAART initiation among postpartum breastfeeding women.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Robert
authors.initials: R
authors.lastname: Ntozini
authors.forename: Kuda
authors.initials: K
authors.lastname: Mutasa
authors.forename: Peter
authors.initials: P
authors.lastname: Iliff
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Ruff
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015992:Body Mass Index; D001942:Breast Feeding / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D049590:Postpartum Period; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D015431:Weight Loss; D055815:Young Adult