The impact of malnutrition on survival and the CD4 count response in HIV‐infected patients starting antiretroviral therapy

Abstract

The impact that malnutrition at the time of starting antiretroviral therapy (ART) has on survival and the CD4 count response is not known. MethodsA retrospective cohort study of patients attending the national HIV referral centre in Singapore who had a CD4 count less than 250 cells/mL and a measurement of body weight performed at the time of starting ART was carried out. Demographic and clinical variables were extracted from an existing database. Body mass index (BMI) was calculated from the weight in kilograms divided by the square of the height in metres. Moderate to severe malnutrition was defined as BMI less than 17 kg/m 2 . Intent-to-treat Cox models were used to determine the predictors of survival. ResultsA total of 394 patients were included in the analysis, of whom 79 died during a median study follow-up of 2.4 years. Moderate to severe malnutrition was present in 16% of patients at the time of starting ART, and was found to be a significant independent predictor of death [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.29-3.73, P 5 0.004 for those with BMIo17 compared with those with BMI418.5] as were stage of disease (HR 2.47, 95% CI 1.20-5.07, P 5 0.014 for those who were at stage C compared with those at stage A) and the type of ART [HR 0.50, 95% CI 0.27-0.93, P 5 0.03 for highly active antiretroviral therapy (HAART) compared with non-HAART treatment]. Malnutrition did not impair the magnitude of the increase in CD4 count at 6 or 12 months. ConclusionsMalnutrition at the time of starting ART was significantly associated with decreased survival, but the effect appeared not to be mediated by impaired immune reconstitution. Given the increasing access to ART in developing countries and the high frequency of HIV-associated wasting, studies of nutritional therapy as an adjunct to the initiation of HAART are urgently needed. 323Studies conducted before the widespread use of ART showed that malnutrition was associated with diminished survival [4,5]. Analysis of a more contemporary cohort of patients, many of whom were taking highly active antiretroviral therapy (HAART), has shown that wasting still occurs and remains an important predictor of death [6,7]. However, no previous study has specifically examined the impact upon survival of malnutrition at the QJ;time of starting ART. It is possible that malnutrition may impair the immune response to ART, prolonging the period during which patients are at risk of opportunistic infection and directly or indirectly increasing the risk of death. Malnutrition may therefore represent a potentially reversible cause of increased mortality in patients who are initiating ART. We performed this analysis using data from a retrospective observational cohort study in order to examine the associations of malnutrition with survival and with CD4 count response in patients commencing ART. MethodsWe used data from the Singapore HIV Observational Cohort Study (SHOCS), a retrospective observational cohort study that has obtained complete data for the cohort of HIVinfected p...

Under Nutrition Status and Its Determinants among Adult HIV and AIDS Clients Enrolled on Antiretroviral Therapy at Nigest Elleni Mohammed Memorial Hospital, Southern Ethiopia

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