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Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for

John R Koethe1, Meridith Blevins, Christopher K Nyirenda

  • 1Centre for Infectious Diseases Research in Zambia, Plot 1275 Lubuto Road, P.O. Box 34681, Lusaka 10101, Zambia ; Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, A2200-MCN, 1161 21st Avenue South, Nashville, TN 37232-2582, USA ; Vanderbilt Institute for Global Health, 2525 West End Avenue, Suite 750, Nashville, TN 37203, USA.

Journal of Nutrition and Metabolism
|May 22, 2013
PubMed

Insights

Low phosphate levels before starting antiretroviral therapy (ART) predict early mortality in undernourished HIV patients. This finding suggests a potential link to refeeding syndrome, highlighting the need for further metabolic research.

Area of Science:

  • Infectious Diseases
  • HIV/AIDS Research
  • Clinical Medicine

Background:

  • Low body mass index (BMI) at antiretroviral therapy (ART) initiation is linked to early mortality in HIV patients.
  • The underlying causes of this mortality risk are not fully understood.
  • Serum phosphate, a key cellular metabolism intermediate, is primarily stored in skeletal muscle.

Purpose of the Study:

  • To investigate the hypothesis that low pretreatment serum phosphate predicts mortality within the first 12 weeks of ART.
  • To examine the association between baseline phosphate levels and early mortality in HIV-infected adults initiating ART.

Main Methods:

  • Prospective study of 352 HIV-infected adults initiating ART in Lusaka, Zambia.
  • Measured baseline serum phosphate levels and adjusted for established mortality predictors (sex, age, CD4(+) lymphocyte count).
  • Estimated the odds of death for each 0.1 mmol/L decrease in baseline phosphate.

Main Results:

  • Lower pretreatment serum phosphate was significantly associated with increased early mortality (OR 1.24 per 0.1 mmol/L decrement, P = 0.01) in participants with BMI <18.5 kg/m(2).
  • No similar association was observed in participants with BMI ≥18.5 kg/m(2) (OR 0.96, P = 0.74).
  • Among 145 participants with low BMI, 28 (19%) died within 12 weeks.

Conclusions:

  • Low pretreatment serum phosphate may predict early ART mortality in undernourished individuals.
  • This association could represent a variant of the refeeding syndrome.
  • Further research into cellular metabolism in this population is warranted.

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