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Association Between Weight Gain and Clinical Outcomes Among Malnourished Adults Initiating Antiretroviral Therapy in Lusaka, Zambia

Koethe, John R MD*†; Lukusa, Anna MD*; Giganti, Mark J MS*; Chi, Benjamin H MD, MSc*‡; Nyirenda, Christopher K MD§; Limbada, Mohammed I MD*; Banda, Yolan MPH*; Stringer, Jeffrey S A MD*‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2010 - Volume 53 - Issue 4 - p 507-513
doi: 10.1097/QAI.0b013e3181b32baf
Epidemiology and Social Science

Objective: To describe the association between 6-month weight gain on antiretroviral therapy (ART) and subsequent clinical outcomes.

Design: A retrospective analysis of a large programmatic cohort in Lusaka, Zambia.

Methods: Using Kaplan-Meier analysis and Cox proportional hazards models, we examined the association between 6-month weight gain and the risk of subsequent death and clinical treatment failure. Because it is a known effect modifier, we stratified our analysis according to body mass index (BMI).

Results: Twenty-seven thousand nine hundred fifteen adults initiating ART were included in the analysis. Patients in the lower BMI categories demonstrated greater weight gain. In the post 6-month analysis, absolute weight loss was strongly associated with mortality across all BMI strata, with the highest risk observed among those with BMI <16 kg/m2 (adjusted hazard ratio 9.7; 95% CI: 4.7 to 20.0). There seemed to be an inverse relationship between weight gain and mortality among patients with BMI <16 kg/m2. Similar trends were observed with clinical treatment failure.

Conclusions: Weight gain after ART initiation is associated with improved survival and decreased risk for clinical failure, especially in the lower BMI strata. Prospective trials to promote weight gain after ART initiation among malnourished patients in resource-constrained settings are warranted.

From the *Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; †Division of Infectious Diseases, Vanderbilt University, Nashville, TN; ‡Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL; and §Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.

Received for publication March 31, 2009; accepted May 22, 2009.

Investigator salary or trainee support is provided by the Fogarty International Center (R24-TW007988, K01-TW06670) and a Clinical Scientist Development Award from the Doris Duke Charitable Foundation (2007061).

No conflicts of interest were reported by any author.

Correspondence to: John R. Koethe, MD, Centre for Infectious Disease Research in Zambia, Plot 1275 Lubuto Road, Lusaka, Zambia (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.