Dietary intake and appetite predict early treatment outcome among low‐BMI adults initiating antiretroviral therapy for HIV in Sub‐Saharan Africa

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.