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Very early anthropometric changes after antiretroviral therapy predict subsequent survival, in karonga, Malawi.

Maman D, Glynn JR, Crampin AC, Kranzer K, Saul J, Jahn A, Mwinuka V, Ngwira MH, Mvula H, Munthali F, McGrath N - Open AIDS J (2012)

Bottom Line: Similar results were found after 6 weeks on ART.Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics.MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.

View Article: PubMed Central - PubMed

Affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France; Université de Lyon, Lyon, F-69000, France; Université Lyon I, Villeurbanne, F-69100, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Pierre-Bénite, F-69310, France.

ABSTRACT

Background: Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality.

Principal findings: Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m(2) (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART.

Conclusions: Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.

No MeSH data available.


Related in: MedlinePlus

(a, b) Mean MUAC and BMI changes by time on ART.
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Figure 2: (a, b) Mean MUAC and BMI changes by time on ART.

Mentions: The mean BMI and MUAC at baseline were 18.6 kg/m2 (95% CI 18.4 to 18.8) and 22.8cm (95%CI 22.6 to 23.1) respectively. The mean changes of BMI and MUAC initially followed a linear trend with time on ART (Fig. 2). The mean increase in BMI was 0.15 kg/m2 (446 observations, 95%CI 0.07 to 0.22) at 2 weeks, 0.45 kg/m² (346 observations, 95%CI 0.33 to 0.58) at 6 weeks and 1.58 kg/m2 (111 observations, 95%CI 1.25 to 1.92) at 6 months after ART initiation (Fig. 2). The mean MUAC change was -0.06cm (444 observations, 95%CI -0.29 to 0.01) after 2 weeks on ART, 0.12cm (346 observations, 95%CI -0.04 to 0.29) at 6 weeks and 1.24cm at 6 months (111 observations, 95%CI 0.87 to 1.62). Using all measurements taken across time points (giving 2492 observations), the Pearson correlation coefficient was 0.86 between the values of BMI and MUAC, suggesting a strong correlation between the two indicators.


Very early anthropometric changes after antiretroviral therapy predict subsequent survival, in karonga, Malawi.

Maman D, Glynn JR, Crampin AC, Kranzer K, Saul J, Jahn A, Mwinuka V, Ngwira MH, Mvula H, Munthali F, McGrath N - Open AIDS J (2012)

(a, b) Mean MUAC and BMI changes by time on ART.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367299&req=5

Figure 2: (a, b) Mean MUAC and BMI changes by time on ART.
Mentions: The mean BMI and MUAC at baseline were 18.6 kg/m2 (95% CI 18.4 to 18.8) and 22.8cm (95%CI 22.6 to 23.1) respectively. The mean changes of BMI and MUAC initially followed a linear trend with time on ART (Fig. 2). The mean increase in BMI was 0.15 kg/m2 (446 observations, 95%CI 0.07 to 0.22) at 2 weeks, 0.45 kg/m² (346 observations, 95%CI 0.33 to 0.58) at 6 weeks and 1.58 kg/m2 (111 observations, 95%CI 1.25 to 1.92) at 6 months after ART initiation (Fig. 2). The mean MUAC change was -0.06cm (444 observations, 95%CI -0.29 to 0.01) after 2 weeks on ART, 0.12cm (346 observations, 95%CI -0.04 to 0.29) at 6 weeks and 1.24cm at 6 months (111 observations, 95%CI 0.87 to 1.62). Using all measurements taken across time points (giving 2492 observations), the Pearson correlation coefficient was 0.86 between the values of BMI and MUAC, suggesting a strong correlation between the two indicators.

Bottom Line: Similar results were found after 6 weeks on ART.Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics.MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.

View Article: PubMed Central - PubMed

Affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France; Université de Lyon, Lyon, F-69000, France; Université Lyon I, Villeurbanne, F-69100, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Pierre-Bénite, F-69310, France.

ABSTRACT

Background: Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality.

Principal findings: Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m(2) (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART.

Conclusions: Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.

No MeSH data available.


Related in: MedlinePlus