Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
Public Health Nutr. 2013 Mar;16(3):549-58. doi: 10.1017/S1368980012002960. Epub 2012 Jun 13.
Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.
A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.
A public-sector HIV clinic in Lusaka, Zambia.
One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.
Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18%) died before 12 weeks and another thirty-three (23%) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16% reduction in the hazard of death (adjusted hazard ratio = 0.84; P = 0.01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.
Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.
在撒哈拉以南非洲开始抗逆转录病毒治疗（ART）的 HIV 感染者中，低 BMI 是早期死亡的主要危险因素，而常见的患者信念是抗逆转录病毒药物会引起令人痛苦的饥饿感，这是治疗依从性的障碍。我们评估了在患有严重营养不良和免疫抑制的 HIV 感染成年人中，ART 开始后 12 周时的食欲、饮食摄入与治疗结果之间的关系。
前瞻性观察队列研究。使用 24 小时回顾性调查评估饮食摄入。使用时变 Cox 模型分析食欲、摄入量和治疗结果之间的关系。
赞比亚卢萨卡的一家公立部门 HIV 诊所。
142 名 BMI<16kg/m2 和/或 CD4+淋巴细胞计数<50 个/μl 的开始接受 ART 的 HIV 感染成年人。
中位年龄、BMI 和 CD4+淋巴细胞计数分别为 32 岁、16kg/m2 和 34 个/μl。25 名参与者（18%）在 12 周前死亡，另有 33 名（23%）失去治疗。在 ART 开始后任何时候，能量摄入增加 500kJ/d，死亡的危险大约降低 16%（调整后的危险比=0.84；P=0.01），但碳水化合物、蛋白质或脂肪相对于总能量的相对贡献并不是结果的显著预测因素。幸存者的食欲逐渐正常化，饥饿感很少被报告。
在一组患有严重营养不良的 HIV 感染成年人中，早期 ART 结果极差，死亡率由较低的饮食摄入预测。在该人群中进行促进 ART 后摄入的干预试验可能有助于提高生存率，是合理的。
