Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Kristin Wall



Correlation Between Nutritional Indicators and Low CD4 Count (<200 cells/mm3 ) among HIV Positive Adults in Kapiri, Zambia 2008-2009

By Kadija C. Fofana


The co-morbidity of malnutrition and HIV is highly prevalent in sub-Saharan Africa due to the pervasiveness of HIV/AIDS and food insecurity in this region. Limited research has been done to assess the association between nutritional indicators and CD4 count among ART-naïve populations in resource scarce settings. It was specifically of our interest to assess various nutritional indicators as factors correlated with low CD4 cell count (< 200 cells/mm3).


From 2008-2009, HIV positive adult males and non-pregnant females completed nutritional assessments at a Medecins Sans Frontiers (MSF) HIV clinic in Kapiri, Zambia. First recorded CD4 cell counts were used in this analysis. In this cross-sectional analysis, sex-stratified multivariate logistic regression models assessed the association between various nutritional indicators and CD4 cell count less than 200 cells/mm3.


51% of males and 50% of females had a first recorded CD4 count of less than 200 cells/mm3. Among males, a mid-upper arm circumference (MUAC) categorization as ‘undernourished’ (aPR= 1.5113, 95% CI = 1.1451-1.9946, p = 0.0035) was associated with CD4 cell count less than 200 cells/mm3. Among females, an MUAC categorization as ‘undernourished’ (aPR = 1.4212, 95% CI 1.1027-1.8318, p= 0.0066) was associated with CD4 cell count less than 200 cells/mm3.


In sex-specific multivariate analyses, MUAC (undernourished) among both males and females was the only nutritional indicator associated with the outcome. It may be of interest to further investigate the impact of MUAC as an insightful anthropometric measure in the evaluation of immunological outcomes among people living with HIV (PLHIV) in light of differences between sex and the overall nutritional status of the studied population.