Nutritional Indicators as Predictors of Opportunistic Infection among HIV-Positive Adults in Kapiri, Zambia 2008-2009 Open Access

Banda, Manka (2016)

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Background: Body Mass Index (BMI) and Mid-Upper Arm Circumference (MUAC) are often used to assess malnutrition among people living with HIV (PLHIV) and predict HIV disease outcomes. These measures do not easily detect early changes in nutritional status, and impaired muscle strength, a condition occurring in disease-related malnutrition, may be a better measure of HIV-associated malnutrition and predictor of HIV disease progression. This study examined if, in addition to the typical anthropometric measures, measures of muscle strength and fatigue predict HIV disease progression.

Methods: From 2008-2009, HIV positive adult males and non-pregnant females were recruited and followed over a 9-month period at a Medecins Sans Frontiers (MSF) HIV clinic in Kapiri, Zambia. Diagnoses of any AIDS-Defining Opportunistic Infection (ADOI) were recorded and multivariate logistic regression models, stratified by sex and CD4 cell count, were assessed to determine the association between incident ADOI and baseline nutritional indicators.

Results: Twenty-eight male subjects (12%) and 47 female subjects (14%) were diagnosed with an ADOI. Seventeen (7.6%) PLHIV with high CD4 cell count (≥ 200 cells/mm3) and 37 (17.7%) with low CD4 cell count were diagnosed with an ADOI. Mean handgrip strength (OR=0.66, 95% CI: 0.55 - 0.78, p=<0.0001) and loss of appetite (OR=2.23, 95% CI: 1.01 - 4.93, p=0.0457) were associated with incident ADOI among females. Mean handgrip strength was also found to be associated with ADOI among those with high CD4 cell count (OR=0.76, 95% CI: 0.62 - 0.93, p=0.0079). Only MUAC was found to be significantly associated with incident ADOI in males and those low CD4 cell count.

Conclusions: As expected, lower MUAC was associated with incident ADOIs in this cohort of ART-naïve HIV-positive adults in Zambia, but surprisingly BMI was not. Two additional metrics of strength and fatigue may be clinically useful in predicting disease progression among women and people with higher initial CD4s. These findings warrant further study, and exploration of additional metrics of disease progression in men and sicker adults are needed.

Table of Contents

Background ------------1

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