Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa
Bibliographic Data
Objective Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression. Design A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models. Setting A public-sector HIV clinic in Lusaka, Zambia. Subjects One hundred and forty-two HIV-infected adults starting ART with BMI 2 and/or CD4 + lymphocyte count Results Median age, BMI and CD4 + lymphocyte count were 32 years, 16 kg/m 2 and 34 cells/μl, respectively. Twenty-five participants (18 %) died before 12 weeks and another thirty-three (23 %) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16 % reduction in the hazard of death (adjusted hazard ratio = 0·84; P = 0·01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported. Conclusions Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted
Appetite · Body mass index · Environmental health · Human immunodeficiency virus (HIV · Demography · HIV Research and Treatment · HIV-related health complications and treatments · HIV/AIDS Research and Interventions · Medicine · Gerontology · Immunology · Internal Medicine · Pediatrics
A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and Aids
Appetite testing in HIV-infected African adults recovering from malnutrition and given antiretroviral therapy
Prevalence and Predictors of Food Insecurity among People Living with HIV Enrolled in Antiretroviral Therapy and Livelihood Programs in Two Rural Zambian Hospitals
Regression Modeling Strategies
Random-Effects Models for Longitudinal Data
Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa
Food Insecurity as a Barrier to Sustained Antiretroviral Therapy Adherence in Uganda
Robust Locally Weighted Regression and Smoothing Scatterplots
Hunger, waiting time and transport costs
Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women
Food insecurity and perceived stress but not HIV infection are independently associated with lower energy intakes among lactating Ghanaian women
The impact of food assistance on weight gain and disease progression among HIV-infected individuals accessing Aids care and treatment services in Uganda
| Unique citing works | 3 |
|---|---|
| Citations per year | 0,25 |
| Citation span | 2014 - 2017 (4) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 3 |