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Dietary intake and appetite predict early treatment outcome among low‐BMI adults initiating antiretroviral therapy for HIV in Sub‐Saharan Africa
Author(s) -
Heimburger Douglas C,
Koethe John R,
Bosire Claire,
Blevins Meridith,
Nyirenda Christopher,
Kabagambe Edmond K,
Zulu Isaac,
Shepherd Bryan E
Publication year - 2012
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.26.1_supplement.1028.13
Subject(s) - medicine , appetite , body mass index , hazard ratio , proportional hazards model , weight loss , overweight , demography , gerontology , obesity , confidence interval , sociology
Low body mass index (BMI), common in patients with HIV in sub‐Saharan Africa, is a risk factor for early mortality on antiretroviral therapy (ART). Many persons in the region believe that ART produces hunger, and this compromises ART adherence. We measured dietary intake (24‐hour recall) & appetite (ordinal scale) in 142 adults starting ART in Lusaka, Zambia with very low BMI (<16 kg/m 2 ) and/or advanced immunosuppression (CD4+ lymphocyte count <50 cells/μL). Relationships with 12‐week outcomes were analyzed with Cox models. Median age, BMI, & CD4+ count were 32 y, 16 kg/m 2 , & 34 cells/μL. Twenty‐five participants (18%) died before 12 weeks, and 33 (23%) were lost to care. A 100 kcal/day higher energy intake at any time after ART initiation was associated with 14% lower hazard of death (AHR=0.86, p=0.01); similar relationships were observed for higher intakes of protein (5 g/day, AHR=0.81, P=0.01) and fat (5 g/day, AHR=0.80, P<0.01), while that for carbohydrate fell short of significance (25 g/day, AHR=0.85, P=0.09). Higher energy intake was marginally associated with a reduction in the combined endpoint of mortality or loss to care (p=0.07). Among survivors, appetite tended to normalize gradually, and hunger was rarely reported. Intervention trials are needed to test the impact of dietary supplementation on early ART outcomes. Funding: NIH R21 AI 076430 & R24 TW 007988.