Abstract
BackgroundBody mass index (BMI) independently predicts mortality in studies of HIV infected patients initiating antiretroviral therapy (ART). We hypothesized that poorer nutritional status would be associated with smaller gains in CD4 count in Rwandan women initiating ART.Methods and FindingsThe Rwandan Women's Interassociation Study and Assessment, enrolled 710 ART-naïve HIV-positive and 226 HIV-negative women in 2005 with follow-up every 6 months. The outcome assessed in this study was change in CD4 count at 6, 12, and 24 months after ART initiation. Nutritional status measures taken prior to ART initiation were BMI; height adjusted fat free mass (FFMI); height adjusted fat mass (FMI), and sum of skinfold measurements. 475 women initiated ART. Mean (within 6 months) pre-ART CD4 count was 216 cells/µL. Prior to ART initiation, the mean (±SD) BMI was 21.6 (±3.78) kg/m2 (18.3% malnourished with BMI<18.5); and among women for whom the following were measured, mean FFMI was 17.10 (±1.76) kg/m2; FMI 4.7 (±3.5) kg/m2 and sum of skinfold measurements 4.9 (±2.7) cm. FFMI was significantly associated with a smaller change in CD4 count at 6 months in univariate analysis (−6.7 cells/uL per kg/m2, p = 0.03) only. In multivariate analysis after adjustment for covariates, no nutritional variable was associated with change in CD4 count at any follow up visit.ConclusionIn this cohort of African women initiating ART, no measure of malnutrition prior to ART was consistently associated with change in CD4 count at 6, 12, and 24 months of follow up, suggesting that poorer pre-treatment nutritional status does not prevent an excellent response to ART.
Highlights
HIV-infection and poor nutritional status are prevalent in Africa
In Rwanda, malnutrition defined by the World Health Organization (WHO) definition of body mass index (BMI), 18.5 kg/m2, [1] is substantially greater than in developed countries [2]; in our preliminary studies of Rwandan HIV-positive women in 2005 approximately 19% were malnourished [3]
The objectives of this study were to examine the association of nutritional status prior to antiretroviral therapy (ART) initiation, using height-normalized measures of body mass, fat-free mass, fat mass, and skin fold thickness, with the change in CD4 count at an average of 6, 12, and 24 months after ART initiation in a cohort of Rwandan women with a high prevalence of malnutrition at study entry
Summary
HIV-infection and poor nutritional status are prevalent in Africa. In Rwanda, malnutrition defined by the World Health Organization (WHO) definition of body mass index (BMI) , 18.5 kg/m2, [1] is substantially greater than in developed countries [2]; in our preliminary studies of Rwandan HIV-positive women in 2005 approximately 19% were malnourished [3].Low body mass index (BMI) and serum albumin have been shown to independently predict mortality in HIV infected persons initiating ART in several United States and African studies [4,5,6,7,8,9]; and may be markers of advanced HIV disease [5,10]. Dietary supplementation with food, which could potentially increase weight and improve nutritional status, has failed to consistently show reductions in HIV mortality in both high- and low-resource settings [11,12]. It is unclear whether nutritional measures such as BMI are markers of more progressive HIV disease and impending mortality, or are functioning independently as causal factors for illness or death; these questions have important programmatic and policy implications for food supplementation for HIV infected persons. We hypothesized that poorer nutritional status would be associated with smaller gains in CD4 count in Rwandan women initiating ART
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