title: A longitudinal study of systemic inflammation and recovery of lean body mass among malnourished HIV-infected adults starting antiretroviral therapy in Tanzania and Zambia.
abstract: OBJECTIVE
  The effects of inflammation on nutritional rehabilitation after starting antiretroviral therapy (ART) are not well understood. We assessed the relationship between inflammation and body composition among patients enrolled in the Nutritional Support for African Adults Starting Antiretroviral therapy (NUSTART) trial in Tanzania and Zambia from 2011 to 2013.
  
  
  METHODS
  HIV-infected, ART-eligible adults with body mass index (BMI) of <18.5 kg/m(2) enrolled in the NUSTART trial were eligible for this study. Anthropometric and body composition data were collected at recruitment and 6 and 12 weeks post ART and C-reactive protein (CRP) was measured at recruitment and 6 weeks. The relationships between CRP and body composition were assessed using multiple regression.
  
  
  RESULTS
  Of the 1815 trial participants, 838 (46%) had baseline and 6-week CRP measurements. Median age was 36 years, 55% were females and median CD4 count was 135 cells/μl. A one-log reduction in CRP at 6 weeks was associated with increased mid-upper arm circumference (0.45 cm; 95% CI: 0.30, 0.61), calf circumference (0.38 cm; 0.23, 0.54), waist circumference (0.98 cm; 0.59, 1.37), BMI (0.37 kg/m(2); 0.24, 0.50) and fat-free mass (0.58 kg; 0.26, 0.91), but not with fat mass (0.09 kg; -0.17, 0.34). Fat-free mass gains persisted at 12 weeks and were more closely associated with 6-week CRP values than with baseline values.
  
  
  CONCLUSIONS
  Reduction in CRP shortly after ART initiation was associated with higher fat-free mass gains. Further studies are warranted to determine whether interventions to reduce systemic inflammation will enhance gains in fat-free mass.
authors.affiliation: Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: G
authors.initials: G
authors.lastname: PrayGod
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.|Vanderbilt Institute for Global Health, Nashville, TN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Blevins
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Woodd
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Rehman
authors.affiliation: Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: K
authors.initials: K
authors.lastname: Jeremiah
authors.affiliation: Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Friis
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.|Barts and The London School of Medicine, Queen Mary University of London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: J
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Heimburger
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Filteau
authors.affiliation: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Koethe
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D018529:Nutritional Support; D011446:Prospective Studies; D013636:Tanzania; D055105:Waist Circumference; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D002097:C-Reactive Protein