Maman David, Glynn Judith R, Crampin Amelia C, Kranzer Katharina, Saul Jacqueline, Jahn Andreas, Mwinuka Venance, Ngwira Msenga Hc, Mvula Hazzie, Munthali Fipson, McGrath Nuala
Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France; Université de Lyon, Lyon, F-69000, France; Université Lyon I, Villeurbanne, F-69100, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Pierre-Bénite, F-69310, France.
Open AIDS J. 2012;6:36-44. doi: 10.2174/1874613601206010036. Epub 2012 Apr 27.
Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality.
Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m(2) (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART.
Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.
马拉维大规模扩大抗逆转录病毒治疗（ART）主要基于临床标准。简单的预后指标很有用，我们研究了极早期人体测量学变化在预测死亡率方面的价值。
2005年9月至2006年8月期间在马拉维北部卡龙加区开始接受抗逆转录病毒治疗的成年患者被纳入一项前瞻性队列研究，并随访长达一年。我们使用Cox回归分析来研究2周和6周时人体测量学变化与第一年死亡之间的关联。纳入了573名患者，其中59%为女性；开始治疗时的中位年龄为37岁，64%处于世界卫生组织第4期。体重指数（BMI）和上臂中部周长（MUAC）均随接受抗逆转录病毒治疗时间的增加呈线性增加，且彼此密切相关。共有118例死亡。接受抗逆转录病毒治疗2周后，BMI增加<0.5kg/m²（风险比2.47，95%置信区间1.24 - 4.94，p = 0.005）或MUAC增加<0.5cm（风险比2.79，95%置信区间1.19 - 6.55，p = 0.008）是死亡的强有力预测指标，在调整基线特征后这些关联更强。接受抗逆转录病毒治疗6周后也发现了类似结果。
抗逆转录病毒治疗2周和6周后的极早期人体测量学变化是生存的强有力预测指标，独立于基线特征。这应有助于在设施有限的情况下识别需要更详细评估的患者。MUAC特别有价值，所需设备最简单，适合无法站立的患者。
