Blevins, MeridithNyirenda, ChristopherZulu, IsaacMwango, AlbertKoethe, John R.Kabagambe, Edmond K.Shepherd, Bryan E.Wester, CChiasera, Janelle M.Mulenga, Lloyd B.Heimburger, Douglas C.2012-06-052011Koethe, 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): 19.1758-2652http://nrs.harvard.edu/urn-3:HUL.InstRepos:8830767Background: 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.en-USJournal Article2012-06-0510.1186/1758-2652-14-19