Department of Medicine, Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA.
J Acquir Immune Defic Syndr. 2012 Oct 1;61(2):179-86. doi: 10.1097/QAI.0b013e318261f064.
To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status.
The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda.
Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics.
Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b = -1.6; 95% confidence interval: -2.7 to -0.45) and ending with the final quarter (b = -6.4; 95% confidence interval: -10.3 to -2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security.
Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.
调查抗逆转录病毒疗法（ART）的时间是否与改善食品安全和营养状况有关，以及这些关联在多大程度上可以通过改善身体健康状况来解释。
乌干达艾滋病农村治疗结局研究，是一项在乌干达姆巴拉拉新开始接受 ART 的 HIV 感染成年人的前瞻性队列研究。
参与者在开始接受 ART 后每季度进行一次结构访谈和血液采集。主要解释变量是 ART 的时间，由每 3 个月的一组二进制变量来构建。结果是食物不安全、营养状况和 PHS。我们使用具有聚类相关稳健方差估计的多元回归模型来解释随时间变化的个体内观察值的依赖性，并对临床和社会人口统计学特征进行了调整。
228 名 ART 初治参与者随访时间长达 3 年，基线时 41%的人严重食物不安全。食物不安全评分呈逐渐下降趋势（线性趋势检验 P<0.0001），从第二个季度开始（b=-1.6；95%置信区间：-2.7 至-0.45），并持续到最后一个季度（b=-6.4；95%置信区间：-10.3 至-2.5）。PHS 和营养状况随着研究随访时间的推移呈线性改善（P<0.001）。在回归模型中纳入 PHS 后，ART 持续时间与食物安全之间的关系减弱。
在乌干达的 HIV 感染者中，在开始接受 ART 后，随着时间的推移，食物不安全状况逐渐减少，营养状况和 PHS 逐渐改善。食物不安全状况的变化部分是由于 PHS 的改善。这些数据支持在资源匮乏的环境中尽早开始 ART，以防止功能状态下降，从而避免食物不安全状况恶化及其对 HIV 治疗结果的不利影响。
