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Association of Pre-treatment Nutritional Status with CD4 and Viral Load Response to ART in Rwandan Women
Kathryn Anastos*1, Q Shi2, D Lu3, J Rusine4, M Cohen5, J Mugabo6, F Ndamage6, A Binagwaho7, D Kotler8, and Rwanda Women's Interassociation Study and Assessment (RWISA)
1Montefiore Med Ctr, Bronx, NY, US; 2New York Med Coll, Valhalla, US; 3Data Solutions LLC, Bronx, NY, US; 4Natl Reference Lab, Ministry of Hlth, Kigali, Rwanda; 5CORE Ctr and Storger Hosp, Chicago, IL, US; 6Treatment and Res on AIDS Ctr, Ministry of Hlth, Kigali, Rwanda; 7Natl Commission to Fight AIDS, Kigali, Rwanda; and 8St Luke`s Hosp Ctr, New York, NY, US
Background: ART is increasingly being provided in
populations with prevalent malnutrition. Few data are available regarding the
effect of nutritional status on response to ART. We hypothesized that poorer
nutritional status would be associated with a less robust CD4 and viral load
response to ART.
Methods: Participants in the Rwandan Women's
Interassociation Study and Assessment (RWISA), a population-based observational
cohort study of 710 ART-naive HIV+ and 226 HIV– women,
were enrolled from May to November 2005 and seen every 6 months, with
historical data and biologic specimens collected, and a directed physical exam
performed. Height, weight, body circumferences, body impedence analysis, CD4
count, HIV-1 RNA (viral load), serum albumin, and hemoglobin were measured, and
fat free mass, total body fat, and body mass index calculated.
Results: After study entry, 450 women initiated ART,
with median duration of use 465 days, pre-HAART CD4 count 260 cells/µL, VL 4.1
log10 and a self-reported adherence of nearly 100%. Median income
was US$37 monthly. The median (interquartile range) albumin was 3.43 (2.99 to
3.8) mg/dL; hemoglobin 13.0 (11.8 to 14.0) g/dL; fat free mass 40.0 (36.9,
43.0) kg; total body fat 12.1 (7.9 to 17.1) kg; and body mass index 20.9 (19.0
to 23.3) kg/m2. Median change in CD4 was +95 (34 to 162) cells/µL,
and in viral load was –3.0 (–3.3 to –2.2) log10. Fat free mass,
total body fat, BMI and albumin were not associated with CD4 response in
univariate or multivariate analysis. Higher total body fat, albumin, hemoglobin,
and body mass index were associated with greater viral load response in
univariate analysis, but only albumin remained significantly associated in
multivariate analysis (estimate 0.42, p = 0.043). In multivariate
logistic regression, the only significant predictors of greater CD4 increase on
ART were lower pre-ART CD4 (estimate –13.7, p = 0.008) and lower income
(–13.1 per category ranging from $9.25 to $250 monthly, p = 0.009). Only
higher albumin and lower pre-ART viral load (estimate –0.96, p <0.0001)
predicted viral load response.
Conclusions: In this cohort of African women
initiating ART, none of the measures of pre-ART nutritional status were
associated with CD4 response, and only albumin was associated with viral load response.
Further study is warranted to confirm this finding, which suggests that poorer
pre-treatment nutritional status does not prevent an excellent response to ART.
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