Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa.
OBJECTIVE
Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.


METHODS
A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.


METHODS
A public-sector HIV clinic in Lusaka, Zambia.


METHODS
One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.


RESULTS
Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18%) died before 12 weeks and another thirty-three (23%) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16% reduction in the hazard of death (adjusted hazard ratio = 0.84; P = 0.01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.


CONCLUSIONS
Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.
Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia. john.r.koethe@vanderbilt.edu
John R
JR
Koethe
Meridith
M
Blevins
Claire
C
Bosire
Christopher
C
Nyirenda
Edmond K
EK
Kabagambe
Albert
A
Mwango
Webster
W
Kasongo
Isaac
I
Zulu
Bryan E
BE
Shepherd
Douglas C
DC
Heimburger
D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001066:Appetite; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D003469:Culture; D004032:Diet; D002149:Energy Intake; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D006801:Humans; D006815:Hunger; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D019370:Observation; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D017741:Survivors; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology
D019380:Anti-HIV Agents