Mild HIV‐induced maternal cachexia predicts adverse birth outcomes in rural Tanzania (620.5)

Abstract

Chronic HIV immune activation alters systemic levels of cytokines regulating appetite and body composition and we hypothesized this is contributing to a mild degree of cachexia that typically remains undetected during pregnancy in food insecure regions. We developed a novel cachexia scoring system adapted to this context that included nutritional status (body mass index, mid‐upper arm circumference), anorexia, quality of life, hemoglobin, CD4, plasma ghrelin and cytokines: IL‐1β, IL‐6, TNF‐α, IFN‐γ, IL‐10. Forty‐four HIV+ (mean CD4=560 cells/µl) women who received antiretrovirals by delivery and 70 HIV‐ pregnant women volunteered for this prospective cohort. Women appeared similar and did not statistically differ by obstetrical histories, demographic, nutritional or clinical factors. More HIV+ women experienced adverse outcomes (combined miscarriage, stillbirth, low birth weight; 14 v 6 %) and delivered infants with lower mean birth weights (3026 v 3299 g; p=0.018) and lengths (45.7 v 47.0 cm; p=0.007). Among HIV+ women, cachexia score predicted lower birth weights (p=0.028) and lengths (p=0.002) indicating the observed cachexia explains in part less favorable birth outcomes in this setting.Grant Funding Source: Mario Einuadi Center for International Studies