title: Nutritional status and mortality among HIV-infected patients receiving antiretroviral therapy in Tanzania.
abstract: BACKGROUND
  Poor nutritional status is associated with immunologic impairment and adverse health outcomes among adults infected with human immunodeficiency virus (HIV).
  
  
  METHODS
  We investigated body mass index (BMI), middle upper arm circumference (MUAC), and hemoglobin (Hgb) concentrations at initiation of antiretroviral therapy (ART) in 18,271 HIV-infected Tanzanian adults and their changes in the first 3 months of ART, in relation to the subsequent risk of death.
  
  
  RESULTS
  Lower BMI, MUAC, and Hgb concentrations at ART initiation were strongly associated with a higher risk of death within 3 months. Among patients who survived >3 months after ART initiation, those with a decrease in weight, MUAC, or Hgb concentrations by 3 months had a higher risk of death during the first year. After 1 year, only a decrease in MUAC by 3 months after ART initiation was associated with a higher risk of death. Weight loss was associated with a higher risk of death across all levels of baseline BMI, with the highest risk observed among patients with BMI <17 kg/m(2) (relative risk, 7.9; 95% confidence interval, 4.4-14.4).
  
  
  CONCLUSIONS
  Poor nutritional status at ART initiation and decreased nutritional status in the first 3 months of ART were strong independent predictors of mortality. The role of nutritional interventions as adjunct therapies to ART merits further investigation.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 1633 Tremont St, Roxbury Crossing, MA 02120, USA. eliu@hsph.harvard.edu
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Helen
authors.initials: H
authors.lastname: Semu
authors.forename: Claudia
authors.initials: C
authors.lastname: Hawkins
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Akum
authors.initials: A
authors.lastname: Aveika
authors.forename: Stella
authors.initials: S
authors.lastname: Nyamsangia
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
authors.forename: Deo
authors.initials: D
authors.lastname: Mtasiwa
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents; D006454:Hemoglobins