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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
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, Volume 14, No. 1, Article 19, Year 2011
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Description
Background: 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/m2 or CD4+ lymphocyte counts of less than 50 cells/mm3, 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. © 2011 Koethe et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Koethe, John Robert
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Nashville
Vanderbilt University School of Medicine
Blevins, Meridith L.
United States, Nashville
Vanderbilt University Medical Center
United States, Nashville
Vanderbilt University School of Medicine
Nyirenda, Christopher K.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
Kabagambe, Edmond Kato
United States, Birmingham
The University of Alabama at Birmingham
Shepherd, Bryan Earl
United States, Nashville
Vanderbilt University School of Medicine
Wester, Carolyn William
United States, Nashville
Vanderbilt University Medical Center
United States, Nashville
Vanderbilt University School of Medicine
United States, Boston
Harvard T.h. Chan School of Public Health
Zulu, Isaac S.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
Chiasera, Janelle M.
United States, Birmingham
The University of Alabama at Birmingham
Mulenga, Lloyd Berdad
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
Mwango, Albert J.
Zambia, Lusaka
Zambian Ministry of Health
Heimburger, Douglas Corbett
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Nashville
Vanderbilt University Medical Center
United States, Nashville
Vanderbilt University School of Medicine
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 11
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1186/1758-2652-14-19
e-ISSN:
17582652
Research Areas
Food Security
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Zambia