Nutrition and inflammation serum biomarkers are associated with 12‐week mortality among malnourished adults initiating antiretroviral therapy in Zambia

Abstract

BackgroundA low body mass index (BMI) at antiretroviral therapy (ART) initiation is a strong predictor of mortality among HIV-infected adults in resource-constrained settings. The relationship between nutrition and inflammation-related serum biomarkers and early treatment outcomes (e.g., less than 90 days) in this population is not well described.MethodsAn observational cohort of 142 HIV-infected adults in Lusaka, Zambia, with BMI under 16 kg/m2 or CD4+ lymphocyte counts of less than 50 cells/mm3, or both, was followed prospectively during the first 12 weeks of ART. Baseline and serial post-treatment phosphate, albumin, ferritin and highly sensitive C-reactive protein (hsCRP) serum levels were measured. The primary outcome was mortality.ResultsLower baseline phosphate and albumin serum levels, and higher ferritin and hsCRP, were significantly associated with mortality prior to 12 weeks (p < 0.05 for all comparisons), independent of known risk factors for early ART-associated mortality in sub-Saharan Africa. The time-dependent interval change in albumin was associated with mortality after adjusting for the baseline value (AHR 0.62 [0.43, 0.89] per 5 g/L increase), but changes in the other biomarkers were not.ConclusionsThe predictive value of serum biomarkers for early mortality in a cohort of adults with malnutrition and advanced HIV in a resource-constrained setting was primarily driven by pre-treatment values, rather than post-ART changes. Interventions to promote earlier HIV diagnosis and treatment, address nutritional deficiencies, and identify the etiologies of increased systemic inflammation may improve ART outcomes in this vulnerable population.

Sustained elevated levels of C-reactive protein and ferritin in pulmonary tuberculosis patients remaining culture positive upon treatment initiation

“…Higher levels of ferritin before ATT were not observed among smokers, alcoholics and HIV infected subjects as described by others [11,23]. Higher CRP and ferritin levels before ATT were however associated with older age, and low BMI as described by Isanaka et al [19].…”

Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury

“…31 Malnourishment during the initial 12 weeks of antiretroviral therapy has also been shown to increase systemic inflammation and mortality. 32 The effectiveness of inflammatory markers in indicating mortality risk has been shown to be affected by malnourishment. In dialysis patients, Hung et al 33 reported that C-reactive protein (CRP), typically associated with higher mortality, was not linked with mortality in patients with good nutritional status, but a strong link between CRP and mortality was observe in malnourished patients.…”

Increased Systemic Inflammation is Associated with Cardiac and Vascular Dysfunction over the First 12 Weeks of Antiretroviral Therapy among Undernourished, HIV-Infected Adults in Southern Africa

“…In the first 90-180 days of ART, the mortality rate among undernourished HIV-infected adults is over 25% in some settings, which is 4 to 6-fold higher than HIV-infected adults with normal BMI and is independent of CD4 T-cell suppression [1-4]. While the etiology of the high early mortality is likely multifactorial, persistent, heightened systemic inflammation is a major risk factor for death in undernourished, HIV-infected adults starting ART in the region [5, 6]. …”