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Serum phosphate predicts early mortality in HIV patients on ART in Zambia
Author(s) -
Heimburger Douglas C,
Nyirenda Christopher,
Kabagambe Edmond K,
Potter Dara,
Bosire Claire,
Zulu Isaac,
ChisembeleTaylor Angela
Publication year - 2009
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.23.1_supplement.918.8
Subject(s) - hypophosphatemia , medicine , anthropometry , antiretroviral therapy , phosphate , refeeding syndrome , human immunodeficiency virus (hiv) , endocrinology , viral load , immunology , malnutrition , biology , biochemistry
Objectives Antiretroviral therapy (ART) programs in developing countries report high mortality rates in the first 90 days of ART. We hypothesize that acute hypophosphatemia, analogous to refeeding syndrome, occurs & is a risk factor for mortality. Methods We enrolled 148 adults with BMI <16 kg/m 2 or CD4 <50/μL at ART initiation in Lusaka, Zambia. Serum phosphate, diet and anthropometrics were recorded 6 times in 12 weeks of ART. Results 2.4% of participants had serum phosphate <0.65 mmol/L (<2 mg/dL) at baseline; this increased to 10.9% after 1 week but decreased again after another week. Mean phosphate dropped ‐0.16±0.33 mmol/L (p<0.001) between weeks 0 & 1. In median 86 days of follow‐up, 28 participants died (93/100 person‐yr). Higher baseline phosphate predicted improved survival (HR 0.15; 95% CI: 0.04‐0.56). This remained significant after adjustment for sex, BMI, & CD4 (HR 0.21; 0.06‐0.82). Sex (HR men vs. women 2.54; 1.05‐6.16) & BMI (HR/unit ↑ in BMI 0.74; 0.59‐0.93) also significantly predicted early mortality, but CD4 count did not. Baseline serum phosphate correlated with CD4 & intakes of protein & fat but not with sex, BMI, appetite, or intakes of energy or carbohydrate. Conclusions Hypophosphatemia occurs in persons with HIV/AIDS in Zambia and may worsen early in ART. Higher phosphate concentrations at ART initiation strongly predict improved survival during ART. Support: UAB CFAR, CIDRZ, NIH AI 076430.