Ventions to decrease the burden of deaths in malnourished patients with

Ventions to decrease the burden of deaths in malnourished patients with advanced HIV disease. Three public hospitals each accounted for approximately onethird of the AIDS hospitalizations in Salvador during 2009?010: the study hospital (32 of hospitalizations), a state general hospital (33 ) and a university hospital (31 ) [16]. All three provided specialized ambulatory AIDS care during the study period. However, only the study hospital and the state general hospital provided 24-hour open-door emergency services. Because patients may either be referred for hospitalization by providers or they may self-present to hospital, those admitted to the study hospital and to the state general hospital are probably more representative of patients with AIDS requiring inpatient care in Salvador. While the study population is probably similar to those at other open-door public hospitals in Brazil, it may not represent AIDS-related admissions throughout the country, particularly those at private institutions. This study has other limitations. We relied on patient recall for retrospective ascertainment of clinical data, including the patient’s weight six months prior to hospitalization and the year of first patient knowledge of HIV disease. Some patients may have confused the distinction between an initial 842-07-9 site notification of HIV infection and a subsequent AIDS diagnosis. Further, given the delay in diagnosis seen in this patient population, this variable probably does not accurately reflect duration of HIV disease. We applied anthropometric measurements to define body fat and muscle mass. Anthropometrics are rough indicators of body composition and are less precise than other methods (e.g.,bioelectrical impedance). However, they are sufficiently accurate for assessing the public health burden of malnutrition [44], as was the aim of this study. Lastly, for bed-bound participants we estimated height and weight to 79983-71-4 custom synthesis calculate BMI, which could have misclassified some patients by nutritional status. Our patient population demonstrated a high level of malnutrition and weight loss at hospital admission in a country long considered to be an international model for HIV care. These results point to substantially unmet nutritional needs for a sizeable group of Brazilians hospitalized with AIDS. They should further reinforce for clinicians the importance of performing nutritional evaluations and simple body composition studies in all patients with HIV [45,46], as malnutrition is a modifiable predictor of death in these individuals [4?]. Improving early testing and HAART adherence strategies, especially for vulnerable populations, may continue to help reduce AIDS-related morbidity and mortality in Brazil. It is nonetheless also critical to identify new methods for interrupting the cycle of poverty, HIV, 1527786 and malnutrition.AcknowledgmentsWe would like to thank the clinical, nutritional and administrative staff of Hospital Couto Maia, especially Norma Sueli 11967625 Pereira for providing support from the hospital nutrition sector and Ceuci Xavier Nunes for critical advice during data analysis and for providing full support for the study as ?the hospital director; Lilian Ramos Sampaio for thoughtful advice on the standardization of the anthropometric exam and data analysis; Ana Marlu ia Assis for providing the anthropometric equipment used in the study; and most of all, the study patients and their families.Author ContributionsConceived and designed the experiments: CSA RPJ TBA NSO.Ventions to decrease the burden of deaths in malnourished patients with advanced HIV disease. Three public hospitals each accounted for approximately onethird of the AIDS hospitalizations in Salvador during 2009?010: the study hospital (32 of hospitalizations), a state general hospital (33 ) and a university hospital (31 ) [16]. All three provided specialized ambulatory AIDS care during the study period. However, only the study hospital and the state general hospital provided 24-hour open-door emergency services. Because patients may either be referred for hospitalization by providers or they may self-present to hospital, those admitted to the study hospital and to the state general hospital are probably more representative of patients with AIDS requiring inpatient care in Salvador. While the study population is probably similar to those at other open-door public hospitals in Brazil, it may not represent AIDS-related admissions throughout the country, particularly those at private institutions. This study has other limitations. We relied on patient recall for retrospective ascertainment of clinical data, including the patient’s weight six months prior to hospitalization and the year of first patient knowledge of HIV disease. Some patients may have confused the distinction between an initial notification of HIV infection and a subsequent AIDS diagnosis. Further, given the delay in diagnosis seen in this patient population, this variable probably does not accurately reflect duration of HIV disease. We applied anthropometric measurements to define body fat and muscle mass. Anthropometrics are rough indicators of body composition and are less precise than other methods (e.g.,bioelectrical impedance). However, they are sufficiently accurate for assessing the public health burden of malnutrition [44], as was the aim of this study. Lastly, for bed-bound participants we estimated height and weight to calculate BMI, which could have misclassified some patients by nutritional status. Our patient population demonstrated a high level of malnutrition and weight loss at hospital admission in a country long considered to be an international model for HIV care. These results point to substantially unmet nutritional needs for a sizeable group of Brazilians hospitalized with AIDS. They should further reinforce for clinicians the importance of performing nutritional evaluations and simple body composition studies in all patients with HIV [45,46], as malnutrition is a modifiable predictor of death in these individuals [4?]. Improving early testing and HAART adherence strategies, especially for vulnerable populations, may continue to help reduce AIDS-related morbidity and mortality in Brazil. It is nonetheless also critical to identify new methods for interrupting the cycle of poverty, HIV, 1527786 and malnutrition.AcknowledgmentsWe would like to thank the clinical, nutritional and administrative staff of Hospital Couto Maia, especially Norma Sueli 11967625 Pereira for providing support from the hospital nutrition sector and Ceuci Xavier Nunes for critical advice during data analysis and for providing full support for the study as ?the hospital director; Lilian Ramos Sampaio for thoughtful advice on the standardization of the anthropometric exam and data analysis; Ana Marlu ia Assis for providing the anthropometric equipment used in the study; and most of all, the study patients and their families.Author ContributionsConceived and designed the experiments: CSA RPJ TBA NSO.