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. 2010 Apr 1;53(4):507-13.
doi: 10.1097/QAI.0b013e3181b32baf.

Association between weight gain and clinical outcomes among malnourished adults initiating antiretroviral therapy in Lusaka, Zambia

John R Koethe  1 , Anna Lukusa, Mark J Giganti, Benjamin H Chi, Christopher K Nyirenda, Mohammed I Limbada, Yolan Banda, Jeffrey S A Stringer
Affiliations

Association between weight gain and clinical outcomes among malnourished adults initiating antiretroviral therapy in Lusaka, Zambia

John R Koethe et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: To describe the association between 6-month weight gain on antiretroviral therapy (ART) and subsequent clinical outcomes.

Design: A retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

Methods: Using Kaplan-Meier analysis and Cox proportional hazards models, we examined the association between 6-month weight gain and the risk of subsequent death and clinical treatment failure. Because it is a known effect modifier, we stratified our analysis according to body mass index (BMI).

Results: Twenty-seven thousand nine hundred fifteen adults initiating ART were included in the analysis. Patients in the lower BMI categories demonstrated greater weight gain. In the post 6-month analysis, absolute weight loss was strongly associated with mortality across all BMI strata, with the highest risk observed among those with BMI <16 kg/m (adjusted hazard ratio 9.7; 95% CI: 4.7 to 20.0). There seemed to be an inverse relationship between weight gain and mortality among patients with BMI <16 kg/m. Similar trends were observed with clinical treatment failure.

Conclusions: Weight gain after ART initiation is associated with improved survival and decreased risk for clinical failure, especially in the lower BMI strata. Prospective trials to promote weight gain after ART initiation among malnourished patients in resource-constrained settings are warranted.

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Conflict of interest statement

No conflicts of interest were reported by any author.

Figures

Figure 1
Figure 1
Description of the patient cohort, Lusaka, Zambia (May 1, 2004 to April 30, 2008) Total patients alive at 6 months with weight data available: 27,915. Abbreviations: ART, antiretroviral therapy; BMI, body mass index.
Figure 2
Figure 2
Time to death stratified by body mass index (BMI) at antiretroviral therapy initiation, Lusaka, Zambia (May 1, 2004 to April 30, 2008; N=40,778)
Figure 3
Figure 3
Figure 3 (A – D): Time to death among patients surviving >6 months after antiretroviral therapy initiation in Lusaka, Zambia (May 1, 2004 to April 30, 2008; N=27,915), stratified according to 6-month weight gain: (A) BMI <16.0, (B) BMI 16.00–16.99, (C) BMI 17.00–18.49, and (D) BMI >18.5 kg/m2. The numbers shown at the bottom of the graphs represent the number of patients active in each six-month weight change category at 90 day intervals.
See this image and copyright information in PMC

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References

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