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Low Phosphorus Linked to Early Death in HIV Therapy

Low levels at initiation of antiretroviral therapy appear to predict early mortality

MONDAY, May 24 (HealthDay News) -- Low blood phosphorus levels are associated with high death rates among HIV-infected patients beginning antiretroviral therapy (ART) in sub-Saharan Africa, according to a study published online May 18 in PLoS ONE.

Douglas C. Heimburger, M.D., of the University of Alabama at Birmingham, and colleagues studied 142 HIV-infected patients initiating ART at a primary care clinic in Lusaka, Zambia, in 2006-07. The patients studied, who had body mass index less than 16 kg/m2 or CD4+ lymphocyte count of less than 50 cells/μL, or both, were monitored for 12 weeks, during which the researchers kept health and dietary intake histories, conducted physical exams, and monitored phosphate, serum ferritin, and high-sensitivity C-reactive protein.

During the study period, 25 of the patients died, with 10 dying within the first four weeks. Baseline phosphorus levels were significantly higher among participants still alive at 12 weeks (median 1.30 mmol/L) than among those who died (median 1.06 mmol/L). Thirteen of the patients were given phosphorus supplements at some time during the study due to severely low levels.

"Low serum phosphate at ART initiation was an independent predictor of early mortality among HIV patients starting ART with severe malnutrition or advanced immunosuppression. This may represent a physiologic phenomenon similar to refeeding syndrome, and may lead to therapeutic interventions that could reduce mortality," the authors write.

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