Nutrition and Inflammation Serum Biomarkers Are Associated with 12-Week Mortality among Malnourished Adults Initiating Antiretroviral Therapy in Zambia
Koethe, John R.
Kabagambe, Edmond K.
Shepherd, Bryan E.
Chiasera, Janelle M.
Mulenga, Lloyd B.
Heimburger, Douglas C.Note: Order does not necessarily reflect citation order of authors.
MetadataShow full item record
CitationKoethe, John R., Meridith Blevins, Christopher Nyirenda, Edmond K. Kabagambe, Bryan E. Shepherd, C. William Wester, Isaac Zulu, et al. 2011. Nutrition and inflammation serum biomarkers are associated with 12-week mortality among malnourished adults initiating antiretroviral therapy in Zambia. Journal of the International AIDS Society 14(1): 19.
AbstractBackground: A low body mass index (BMI) at antiretroviral therapy (ART) initiation is a strong predictor of mortality among HIV-infected adults in resource-constrained settings. The relationship between nutrition and inflammation-related serum biomarkers and early treatment outcomes (e.g., less than 90 days) in this population is not well described. Methods: An observational cohort of 142 HIV-infected adults in Lusaka, Zambia, with BMI under \(16 kg/m^2\) or \(CD4^+\) lymphocyte counts of less than \(50 cells/mm^3\), or both, was followed prospectively during the first 12 weeks of ART. Baseline and serial post-treatment phosphate, albumin, ferritin and highly sensitive C-reactive protein (hsCRP) serum levels were measured. The primary outcome was mortality. Results: Lower baseline phosphate and albumin serum levels, and higher ferritin and hsCRP, were significantly associated with mortality prior to 12 weeks (p < 0.05 for all comparisons), independent of known risk factors for early ART-associated mortality in sub-Saharan Africa. The time-dependent interval change in albumin was associated with mortality after adjusting for the baseline value (AHR 0.62 [0.43, 0.89] per 5 g/L increase), but changes in the other biomarkers were not. Conclusions: The predictive value of serum biomarkers for early mortality in a cohort of adults with malnutrition and advanced HIV in a resource-constrained setting was primarily driven by pre-treatment values, rather than post-ART changes. Interventions to promote earlier HIV diagnosis and treatment, address nutritional deficiencies, and identify the etiologies of increased systemic inflammation may improve ART outcomes in this vulnerable population.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:8830767
- SPH Scholarly Articles