ArticleBMC infectious diseases2016
Risk factors for mortality among malnourished HIV-infected adults eligible for antiretroviral therapy.
Article in BMC infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Growth and body composition of adolescents and young adults with perinatal HIV infection: a systematic review and meta-analysis.BMC public health · 2025Pooled it
- Pooled it
- Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis.BMC infectious diseases · 2021Pooled it
- Effects on body composition and handgrip strength of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial.Journal of nutritional science · 2019Trial
- Associations of prior wasting malnutrition with later indicators of glucose tolerance across 4 countries in Africa and Asia: The Severe Acute Malnutrition - the Role of the Pancreas (SAMPA) study.The American journal of clinical nutrition · 2025Article
- C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review.JAC-antimicrobial resistance · 2023Review
- Relationship Between Handgrip Strength and Age in the Body Composition Variables Among People Living with HIV.Current HIV research · 2022Article
- Prior undernutrition and insulin production several years later in Tanzanian adults.The American journal of clinical nutrition · 2021Article
- Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions.Current HIV/AIDS reports · 2021Review
- An optimal BMI range associated with a lower risk of mortality among HIV-infected adults initiating antiretroviral therapy in Guangxi, China.Scientific reports · 2019Article
- Article
- Changes in serum phosphate and potassium and their effects on mortality in malnourished African HIV-infected adults starting antiretroviral therapy and given vitamins and minerals in lipid-based nutritional supplements: secondary analysis from the Nutritional Support for African Adults Starting Antiretroviral Therapy (NUSTART) trial.The British journal of nutrition · 2017Article
- High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model.BMC nutrition · 2017Article
- Determinants and outcomes of low birth weight among newborns at a tertiary hospital in Zambia: A retrospective cohort study.Annals of African medicineArticle
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 5 countries.
Funding
Abstract
backgroundA substantial proportion of HIV-infected adults starting antiretroviral therapy (ART) in sub-Saharan Africa are malnourished. We aimed to increase understanding of the factors affecting their high mortality, particularly in the high-risk period before ART initiation.
methodsWe analysed potential risk factors for mortality of Zambian and Tanzanian participants enrolled in the NUSTART clinical trial. Malnourished adults (n = 1815; body mass index [BMI] <18.5 kg/m
resultsThe mortality rate was higher in the period from referral to starting ART (121 deaths/100 person-years; 95 % CI 103, 142) than during the first 12 weeks of ART (66; 95 % CI 57, 76) and was not affected by trial study arm. In adjusted analyses, lower CD4 count, BMI and mid-arm circumference and raised C-reactive protein were associated with an increased risk of mortality throughout the study. Male sex and lower hand-grip strength carried an increased risk in the pre-ART period. Participants on tuberculosis treatment at referral had a lower mortality rate (adjusted Rate Ratio 0.44; 95 % CI 0.31, 0.63).
conclusionAmong malnourished ART-eligible adults, pre-ART mortality was twice that in the early post-ART period, suggesting many early ART deaths represent advanced HIV disease rather than treatment-related events. Therefore, more efforts are needed to promote earlier diagnosis and immediate initiation of ART, as recently recommended by WHO for all persons with HIV worldwide. The positive effect of tuberculosis treatment suggests undiagnosed tuberculosis is a contributor to mortality in this population.
trial registrationPan African Clinical Trials Registry, PACTR201106000300631 ; registered on 1st June 2011.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.