Department of Nutrition, Harvard School of Public Health, 1633 Tremont St, Roxbury Crossing, MA 02120, USA.
J Infect Dis. 2011 Jul 15;204(2):282-90. doi: 10.1093/infdis/jir246.
Poor nutritional status is associated with immunologic impairment and adverse health outcomes among adults infected with human immunodeficiency virus (HIV).
We investigated body mass index (BMI), middle upper arm circumference (MUAC), and hemoglobin (Hgb) concentrations at initiation of antiretroviral therapy (ART) in 18,271 HIV-infected Tanzanian adults and their changes in the first 3 months of ART, in relation to the subsequent risk of death.
Lower BMI, MUAC, and Hgb concentrations at ART initiation were strongly associated with a higher risk of death within 3 months. Among patients who survived >3 months after ART initiation, those with a decrease in weight, MUAC, or Hgb concentrations by 3 months had a higher risk of death during the first year. After 1 year, only a decrease in MUAC by 3 months after ART initiation was associated with a higher risk of death. Weight loss was associated with a higher risk of death across all levels of baseline BMI, with the highest risk observed among patients with BMI <17 kg/m(2) (relative risk, 7.9; 95% confidence interval, 4.4-14.4).
Poor nutritional status at ART initiation and decreased nutritional status in the first 3 months of ART were strong independent predictors of mortality. The role of nutritional interventions as adjunct therapies to ART merits further investigation.
在感染人类免疫缺陷病毒 (HIV) 的成年人中，营养状况不良与免疫功能受损和不良健康结局相关。
我们调查了 18271 名坦桑尼亚 HIV 感染成年患者在开始接受抗逆转录病毒治疗 (ART) 时的体重指数 (BMI)、中上臂围 (MUAC) 和血红蛋白 (Hgb) 浓度，以及在 ART 治疗的前 3 个月内这些指标的变化与随后死亡风险的关系。
在开始 ART 时 BMI、MUAC 和 Hgb 浓度较低与 3 个月内死亡风险较高密切相关。在存活 >3 个月的患者中，在 3 个月时体重、MUAC 或 Hgb 浓度下降的患者在第一年死亡风险更高。1 年后，仅在开始 ART 后 3 个月 MUAC 下降与死亡风险较高相关。体重减轻与所有基线 BMI 水平的死亡风险增加相关，在 BMI <17 kg/m2 的患者中观察到的风险最高 (相对风险，7.9；95%置信区间，4.4-14.4)。
在开始 ART 时营养状况不良和在 ART 的前 3 个月内营养状况下降是死亡的强烈独立预测因素。营养干预作为 ART 的辅助治疗的作用值得进一步研究。
