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Predictors of weight loss after HAART initiation among HIV-infected adults in Tanzania

Li, Nana; Spiegelman, Donnab; Drain, Paulc,d; Mwiru, Ramadhani S.a; Mugusi, Ferdinande; Chalamilla, Guerinof; Fawzi, Wafaie W.g

doi: 10.1097/QAD.0b013e32834f9851
Clinical Science

Objective: To explore the predictors of weight loss after highly active antiretroviral therapy (HAART) initiation in a large cohort of HIV-infected adults living in Dar es Salaam, Tanzania.

Design: Cross-sectional and longitudinal analysis of a cohort of HIV-infected adults on HAART.

Methods: HIV-infected adults (n = 18 965) were enrolled between November 2004 to December 2009 in Dar es Salaam, Tanzania. Log-binomial regression and Cox proportional hazard regression were used to explore the predictors of short-term (3 months) and long-term significant weight loss (≥5%) after HAART initiation.

Results: At 3 months after HAART initiation, 8% patients lost greater than or equal to 5% weight. Underweight patients at initiation gained more weight than other body mass index (BMI) groups. Younger or older than age group 30–39, lower socioeconomic status (SES), higher BMI, lower hemoglobin, difficulty breathing, loss of appetite, nausea/vomiting at baseline were associated with the risk of significant weight loss at 3 months after initiation. During a median follow-up period of 10 months [interquartile range (IQR) 4–20 months], 31% patients had experienced an initial significant weight loss after HAART initiation. In addition to time-varying CD4 cell count and hemoglobin level, age, sex, baseline BMI and having loss of appetite, and nausea/vomiting at baseline were associated with the risk of long-term significant weight loss.

Conclusion: Our study suggested that a significant percentage of patients continue to lose weight after HAART initiation. Our findings on the effect of socio-demographics, symptoms and diseases, biomedical indicators in relation to weight loss provide important information that has significant practical implications.

aDepartment of Nutrition

bDepartments of Epidemiology and Biostatistics, School of Public Health, Harvard University

cDivision of Infectious Diseases, Brigham and Women's Hospital

dDivision of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA

eDepartment Internal Medicine, Muhimbili University of Health and Allied Sciences

fManagement and Development for Health (MDH), Dar es Salaam, Tanzania

gDepartments of Nutrition and Global Health and Population, School of Public Health, Harvard University, Boston, Massachusetts, USA.

Correspondence to Nan Li, PhD, MHS, Harvard School of Public Health, 1633 Tremont St, Boston, MA 02120, USA. E-mail: nli@hsph.harvard.edu

Received 24 July, 2011

Revised 3 November, 2011

Accepted 23 November, 2011

© 2012 Lippincott Williams & Wilkins, Inc.