{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T07:33:15Z","timestamp":1773732795225,"version":"3.50.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000308","name":"Carnegie Corporation of New York","doi-asserted-by":"publisher","award":["G-19-57145"],"award-info":[{"award-number":["G-19-57145"]}],"id":[{"id":"10.13039\/100000308","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004441","name":"Sida","doi-asserted-by":"crossref","award":["54100113"],"award-info":[{"award-number":["54100113"]}],"id":[{"id":"10.13039\/100004441","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107768\/Z\/15\/Z"],"award-info":[{"award-number":["107768\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministry of Health, Community Development, Gender, Elderly and Children Tanzania"},{"name":"the Government of the Canton of Basel, Switzerland"},{"name":"The Swiss Tropical and Public Health Institute, Switzerland"},{"name":"the University Hospital Basel, Switzerland"},{"name":"the Ifakara Health Institute, Tanzania"},{"name":"USAID Boresha Afya (through the United States Agency for International Development (USAID) from the President's Emergency Plan for AIDS Relief"},{"name":"UK Foreign, Commonwealth & Development Office"},{"name":"Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Increased body weight is an important risk factor for cardiovascular disease and is increasingly reported as a health problem in people living with HIV (PLHIV). There is limited data from rural sub-Saharan Africa, where malnutrition usually presents with both over- and undernutrition. We aimed to determine the prevalence and risk factors of underweight and overweight\/obesity in PLHIV enrolled in a cohort in rural Tanzania before the introduction of integrase inhibitors.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort included adults aged \u226519 years initiated on antiretroviral therapy between 01\/2013 and 12\/2018 with follow-up through 06\/2019. Body Mass Index (BMI) was classified as underweight (&lt;18.5 kg\/m<jats:sup>2<\/jats:sup>), normal (18.5\u201324.9 kg\/m<jats:sup>2<\/jats:sup>), or overweight\/obese (\u226525.0 kg\/m<jats:sup>2<\/jats:sup>). Stratified piecewise linear mixed models were used to assess the association between baseline characteristics and follow-up BMI. Cox proportional hazard models were used to assess the association between time-updated BMI and death\/loss to follow-up (LTFU).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Among 2,129 patients, 22,027 BMI measurements (median 9 measurements: interquartile range 5\u201315) were analysed. At baseline, 398 (19%) patients were underweight and 356 (17%) were overweight\/obese. The majority of patients were female (n = 1249; 59%), and aged 35\u201344 years (779; 37%). During the first 9 months, for every three additional months on antiretroviral therapy, BMI increased by 2% (95% confidence interval 1\u20132%, p&lt;0.0001) among patients underweight at baseline and by 0.7% (0.5\u20130.6%, p&lt;0.0001) among participants with normal BMI. Over a median of 20 months of follow-up, 107 (5%) patients died and 592 (28%) were LTFU. Being underweight was associated with &gt;2 times the hazard of death\/LTFU compared to participants with normal BMI.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>We found a double burden of malnutrition, with underweight being an independent predictor of mortality. Monitoring and measures to address both states of malnutrition among PLHIV should be integrated into routine HIV care.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0290445","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T17:26:57Z","timestamp":1692725217000},"page":"e0290445","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5862-9264","authenticated-orcid":true,"given":"Aneth 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