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Abraham A, Kawuki J, Aragie T, Elias C, Birahanu Z, Dawit D, Israel E. Nearly half of HIV-positive children attending public health facilities are suffering from chronic under-nutrition in conflict-affected zones of Southern Ethiopia. Front Nutr 2024; 11:1356931. [PMID: 38694221 PMCID: PMC11061431 DOI: 10.3389/fnut.2024.1356931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/29/2024] [Indexed: 05/04/2024] Open
Abstract
Background In combination with HIV infection, malnutrition is a complicated medical condition with high morbidity and mortality rates in affected children due to a variety of socioeconomic and medical etiological variables. To combat this, information from a range of contexts is required, but there is little evidence, particularly about the nutritional status of under 15 living with HIV in impoverished communities such as conflict affected areas. Therefore, in this study the magnitude and related factors of stunting among under 15 children antiretroviral therapy at public health facilities was assessed. Methods An institution-based cross-sectional study was conducted among under 15 children living with HIV in conflict-affected zones of Southern Ethiopia. After providing written informed consent to study participants, data were collected using an interviewer-administered questionnaire and anthropometric measurements. Bivariable and multivariable logistic regression models were used to identify factors associated with nutritional status, using SPSS Version 25. Results Of the 401 participants, 197 (49.1%, 95% CI: 0.44, 0.54) had height-for-age z-score ≤ -2. In the multivariable analysis, larger household size (AOR = 1.58, 95% CI: 1.04-2.40), dietary diversity (AOR = 1.78; 95% CI: 1.07-2.96) and having a history of recurrent diarrhea (AOR = 1.96; 95% CI: 1.07-3.59) were significantly associated with chronic under nutrition. Conclusions The prevalence found in this study was high when compared with the stunting target set in SDG, which states to end all forms of malnutrition In order to mitigate the negative health effects of diarrhea during HIV therapy, extra attention needs to be paid to facilitate timely detection and on-going monitoring. Nutrition programs in conflict-affected areas need to consider households with larger family sizes and/or routinely having fewer food groups.
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Affiliation(s)
- Awoke Abraham
- Division of Nutrition, Maternal and Child Health Unit, Wolaita Zone Health Department, Sodo, Ethiopia
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tesfaye Aragie
- Department of Public Health, Private Sector Support Officer, Marie Stopes International Ethiopia Reproductive Choices, Hawassa, Ethiopia
| | - Cherinet Elias
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Zewudu Birahanu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Desalegn Dawit
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Singh MV, Sharma S, Shrivastava A, Shukla SK, Siddiqui SA, Maurya M, Mishra N, Yadav RK. Effect of the timing of antiretroviral treatment initiation on CD4 count in children and youths living with HIV in North India. Int J STD AIDS 2024; 35:389-396. [PMID: 38214670 DOI: 10.1177/09564624241226489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Immediate start of antiretroviral treatment (ART) among non-hospitalized outpatient children living with HIV may improve or worsen clinical outcomes due to immune reconstitution. OBJECTIVE Role of immediate versus post-stabilization start of antiretroviral treatment in children and youths living with HIV on CD4 count and viral load suppression. METHODS This was a single blinded, randomized controlled trial conducted on outpatients attending a tertiary care hospital associated HIV clinic in North India. We enrolled ART-naive children and youths living with HIV aged 18 months to 21 years in a 1:1 ratio. Block randomization was done using computerized software. Children and youths living with HIV were either started with ART on diagnosis immediately within 24 h (Group A) or post stabilization at 2 weeks (Group B) as per National AIDS Control Organization (NACO) India guidelines. Both groups were comparable for baseline characteristics. RESULTS There was no significant difference seen in CD4 counts between two groups at 6 months follow up. CD4 count increased significantly in immediate group but not in post-stabilization group at 6 months. No significant changes/differences was seen in WHO clinical staging or anthropometry; one patient developed tuberculosis in both groups. Viral load at 6 months in both the groups did not differ significantly. CONCLUSION Immediate ART in children and youths living with HIV results in significant increase in CD4 count at 6 months follow up exemplifying immunological response to ART.
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Affiliation(s)
- Mukesh Vir Singh
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Sukesh Sharma
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Anubha Shrivastava
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Santosh Kumar Shukla
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Shahid Akhtar Siddiqui
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Manisha Maurya
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Nandita Mishra
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
| | - Rajesh Kumar Yadav
- Department of Pediatrics, Sarojini Naidu Children Hospital, Moti Lal Nehru Medical College, Prayagraj, India
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Wohlfeiler MB, Weber RP, Brunet L, Siddiqui J, Harbour M, Phillips AL, Hayward B, Fusco JS, Hsu RK, Fusco GP. Incident HIV-Associated Wasting/Low Weight Is Associated with Nearly Doubled Mortality Risk in the Modern ART Era. AIDS Res Hum Retroviruses 2024. [PMID: 38481376 DOI: 10.1089/aid.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
HIV-associated wasting (HIVAW) is an underappreciated AIDS-defining illness, despite highly effective antiretroviral therapy (ART). We (a) assessed the association between incident HIVAW/low weight and all-cause mortality and (b) described virologic outcomes after people with HIV (PWH) experienced HIVAW/low weight while on ART. In the Observational Pharmaco-Epidemiology Research & Analysis (OPERA®) cohort, PWH without prior HIVAW/low weight who were active in care in 2016-2020 were followed through the first of the following censoring events: death, loss to follow-up, or study end (October 31, 2021). HIVAW/low weight was a diagnosis of wasting or low body mass index (BMI)/underweight or a BMI measurement <20 kg/m2. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent HIVAW/low weight and mortality were estimated with extended Cox regression models. Over a median follow-up of 45 months (interquartile range: 27, 65), there were 4,755 (8%) cases of HIVAW/low weight and 1,354 (2%) deaths among 62,314 PWH. PWH who experienced HIVAW/low weight had a significantly higher risk of death than those who did not (HR: 1.96; 95% CI: 1.68, 2.27) after adjusting for age, race, ethnicity, and changes in viral load (VL) and Veterans Aging Cohort Study Mortality Index scores over follow-up. Among 4,572 PWH on ART at HIVAW/low weight, 68% were suppressed (VL of <200 copies/mL); subsequent virologic failure was uncommon (7%). Among viremic PWH, 70% and 60% achieved suppression and undetectability (VL of <50 copies/mL), respectively, over follow-up. HIVAW remains a challenge for some PWH. Particular attention needs to be paid to HIVAW/low weight and virologic control to restore health and potentially reduce the risk of death.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ricky K Hsu
- AIDS Healthcare Foundation, New York, New York, USA
- NYU Langone Medical Center, New York, New York, USA
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Cordeiro SA, Lopes TCP, Boechat AL, Gonçalves RL. Weight loss and mortality in people living with HIV: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:34. [PMID: 38166819 PMCID: PMC10762994 DOI: 10.1186/s12879-023-08889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In the first reported cases of human immunodeficiency virus (HIV) infection, people living with HIV (PLHIV) suffered weight loss, which was an independent predictor of mortality. Highly active antiretroviral therapy (HAART) has changed this scenario for ideal weight, overweight, and even obesity. However, some PLHIV, even on HAART, continue to lose weight. Thus, the guiding question of the study was: do PLHIV hospitalized using HAART with weight loss have higher mortality than hospitalized PLHIV using HAART without weight loss? METHOD A systematic review and meta-analysis of prospective cohort studies published in English, Spanish, or Portuguese, searched in the MedLine, Embase, and LILACS databases from March 2020, until October 2023, reported by MOOSE. We analyzed the methodological quality and risk of bias using the Joanna Briggs Institute Critical Appraisal Tool for Cohort Studies; used the risk ratio (RR) to calculate the probability of hospitalized PLWH who lost weight dying, applied the random effect model and created the funnel plot. We used the inverse variance test estimated by the Mantel-Haenszel method, considering a 95% confidence interval (CI), heterogeneity (I2), total effect size (Z), and significance value of p < 0.05. We performed a sensitivity analysis with meta-regression and meta-analyses on subgroups to diagnose influence and outliers. The quality of evidence and strength of recommendation were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE). RESULTS We included 10 of the 711 studies identified, totaling 1,637 PLHIV. The studies were from South Africa (1), Canada (1), China (1), Brazil (1), Cameroon (1), Ethiopia (1), Thailand (1), Colombia (1), and Tanzania (2), from 1996 to 2017. The average age of the participants was 33.1 years old, and the male was predominant. The leading causes of hospital admission were related to co-infections, and the average hospitalization time was 20.5 days. The prevalence of death in hospitalized PLHIV using HAART who lost weight was 57.5%, with a 1.5 higher risk of dying (RR: 1.50, 95% CI: 1.03, 2.19, p = 0.04) than hospitalized PLHIV who did not lose weight. CONCLUSION We concluded, with a very low confidence level, that that weight loss significantly increased the risk of death in hospitalized PLWH using HAART. TRIAL REGISTRATION AND FUNDING PROSPERO International Prospective Register of Systematic Reviews CRD42020191246 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020191246 .
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Affiliation(s)
- Sarah Almeida Cordeiro
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil.
| | - Tainá Costa Pereira Lopes
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
| | - Antonio Luiz Boechat
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
| | - Roberta Lins Gonçalves
- Program in Health Sciences (PPGCIS), Faculty of Medicine, Federal University of Amazonas - UFAM, Afonso Pena Street, 1053, Centro, Manaus, Amazonas, Brazil
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Migdanis A, Migdanis I, Papadopoulou SK, Hadjivasiliou L, Trifonova N, Villioti M, Giaginis C, Kosti RI, Androutsos O. Αssessment of Dietary Intake and Nutritional Status of Former Opioid Users Undergoing Detoxification Process. Cureus 2023; 15:e50068. [PMID: 38186545 PMCID: PMC10767476 DOI: 10.7759/cureus.50068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
RATIONALE Opioid dependence is often associated with impaired nutritional status, weight changes, nutritional deficiencies, and increased sugar consumption. Scientific quantified data on the dietary habits and intake of such patients are sparse. METHODS This was a cross-sectional study. The study was conducted among 60 male and female former heroin addicts, who sought detoxification at the OKANA replacement therapy unit, in a public university hospital. All patients were treated for their addiction with buprenorfine/naloxone in combination with counseling. With the use of an administered questionnaire, several parameters were assessed and recorded, including nutritional habits, anthropometric characteristics, recent weight and medical history, and physical activity level of the participants. Additionally, a three-day dietary recall was performed and quantified with the aid of nutritional analysis software. The results were compared with the macronutrient requirements, calculated total energy expenditure, and the population reference intake (PRI) of the participants. Finally, the level of compliance of the participants to the Mediterranean diet model was assessed using the Mediterranean diet score tool. RESULTS The vast majority of the participants (77%) had a normal BMI of 18.5-25, and 15% were categorized as underweight (<18.5). Furthermore, 63% of the patients reported a mean unintended weight reduction of 9 kg over the last three months. Regarding mean energy and protein intake, no significant differences between reported intake and calculated requirements were recorded. Sugar consumption was high since it reached 20% of the total energy intake. Micronutrient intake was significantly lower for vitamins K, E, and C and potassium compared with the PRI (p=0.034, p=0.001, p=0.046, and p=0.001, respectively). Finally, a low adherence of the participants to the Mediterranean diet model was observed since 38% scored ≤15 and 62% ≤ 30 on the Mediterranean diet score tool. CONCLUSIONS According to the results of the study, the general nutritional status of this category of patients seems to be impaired, presenting an apparent weight reduction and an inadequate intake of some micronutrients and displaying disturbed eating behaviors. Further data on the field are required to build a future evidence base. Dietary assessment and individualized nutritional counseling, when necessary, might need to be incorporated into the typical clinical management of this patient category to avoid nutritional deficiencies and improve the withdrawal process.
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Affiliation(s)
- Athanasios Migdanis
- Faculty of Medicine, University of Thessaly, Larissa, GRC
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
| | - Ioannis Migdanis
- Faculty of Medicine, University of Thessaly, Larissa, GRC
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
| | - Sousana K Papadopoulou
- Department of Nutrition and Dietetics, International Hellenic University, Thessaloniki, GRC
| | | | - Nevena Trifonova
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
| | - Maria Villioti
- Faculty of Medicine, University of Thessaly, Larissa, GRC
| | | | - Rena I Kosti
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
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Wohlfeiler MB, Weber RP, Brunet L, Siddiqui J, Harbour M, Phillips AL, Hayward B, Fusco JS, Hsu RK, Fusco GP. Definition, Burden, and Predictors of HIV-Associated Wasting and Low Weight in the OPERA Cohort. AIDS Res Hum Retroviruses 2023; 39:636-643. [PMID: 37489298 PMCID: PMC10712360 DOI: 10.1089/aid.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We aimed to describe the prevalence, incidence, and predictors of HIV-associated wasting (HIVAW)/low weight among people with HIV (PWH) in the United States. We conducted an observational, clinical cohort analysis, utilizing prospectively collected electronic health record data obtained from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA®) cohort. HIVAW/low weight included a wasting or low body-mass index (BMI)/underweight diagnosis (ICD codes and title search) or BMI <20 kg/m2. Prevalence was estimated among adult PWH in care from 2012 to 2015 and 2016 to 2020. Incidence from January 1, 2016, to October 31, 2021, was estimated using univariate Poisson regression among eligible PWH without prior HIVAW/low weight. Demographic and clinical predictors of incident HIVAW/low weight were included in multivariable logistic regression models, stratified by antiretroviral therapy (ART) experience. The period prevalence of HIVAW/low weight was 12% in both 2012-2015 and 2016-2020. Among 67,119 PWH without any prior HIVAW/low weight, 7% experienced incident HIVAW/low weight a median 64 months from HIV diagnosis. In multivariable regression models, similar predictor patterns were observed among ART-naïve and ART-experienced PWH without any prior HIVAW/low weight: lower odds of HIVAW/low weight with older age, female sex, Black race, and Hispanic ethnicity and higher odds with Medicaid. Notably, there was a dose-response relationship between increasing Veterans Aging Cohort Study Mortality Index scores and incident HIVAW/low weight in both groups. Wasting/low weight remains a challenge for PWH and may be underappreciated by providers. Advanced HIV and comorbidities significantly predict incident HIVAW/low weight. Increasing awareness of HIVAW, especially among frailer PWH, could improve the care of affected PWH.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ricky K. Hsu
- AIDS Healthcare Foundation, New York, New York, USA
- NYU Langone Medical Center, New York, New York, USA
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Arnab P, Croxford R, Scott J, Perumal S, Mohammed Z, Wiesner L, Cohen K, Wasserman S. Severe efavirenz associated neurotoxicity: A retrospective cohort study. S Afr J Infect Dis 2023; 38:522. [PMID: 37780199 PMCID: PMC10397354 DOI: 10.4102/sajid.v38i1.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/09/2023] [Indexed: 10/03/2023] Open
Abstract
Background Efavirenz (EFV) is associated with neuropsychiatric symptoms. Severe neurotoxicity has been reported but the clinical phenotype and risk factors are poorly defined. Objectives To characterise clinical presentations, risk factors and outcomes to help clinicians recognise severe neurotoxicity earlier. Method The authors retrospectively identified adults with supratherapeutic EFV concentrations (> 4 mg/L) obtained during routine clinical care in Cape Town, South Africa. Clinical and laboratory data at the time of EFV quantification were extracted from medical records. Logistic regression was performed to identify associations with neuropsychiatric symptoms, and with severe neurotoxicity. Results Eighty one patients were included; 62 with neuropsychiatric manifestations (most frequently ataxia [n = 20] and psychomotor slowing [n = 24]); and 19 with hepatotoxicity. Overall, 28 (34.6%) were male, 49 (60.5%) had concomitant isoniazid exposure, and median EFV concentration was 12.1 mg/L (interquartile range [IQR]: 6.6-20.0). Neuropsychiatric symptoms were associated with longer duration of EFV therapy, adjusted odds ratio (aOR) 1.3/180-day increment (95% confidence interval [CI]: 1.0-1.7); higher EFV concentrations, aOR 1.2/1 mg/L increase (95% CI: 1.0-1.4) and isoniazid exposure, aOR 8.2 (95% CI: 2.5-26.7). Severe neuropsychiatric symptoms occurred in 47 (75%) patients at a median of 5.9 months (IQR: 2.1-40.8) after EFV initiation. Severe symptoms odds were 1.2-fold higher (95% CI: 1.1-1.4) per 1 mg/L increase in EFV concentration. Symptoms resolved completely within 1 month in 25 (76%) patients with severe neurotoxicity who discontinued EFV. Conclusion A concentration-effect relationship for severe neurotoxicity exists, which occurred late and resolved in most patients after EFV discontinuation. Contribution The authors highlighted clinical heterogeneity and morbidity of EFV-associated neurotoxicity.
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Affiliation(s)
- Priyadarshini Arnab
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roland Croxford
- Department of Health, DP Marais Hospital, Western Cape Government, Cape Town, South Africa
| | - Janet Scott
- Department of Health, DP Marais Hospital, Western Cape Government, Cape Town, South Africa
| | - Sameshan Perumal
- Department of Statistics, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Zahraa Mohammed
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Bahji A, Gordon KS, Crystal S, Satre DD, Wiliams EC, Edelman EJ, Justice AC. Factors Associated with Bothersome Symptoms in Individuals With and Without HIV Who Report Alcohol Use. AIDS Behav 2023; 27:2455-2462. [PMID: 36622487 PMCID: PMC10225332 DOI: 10.1007/s10461-022-03972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
Bothersome symptoms potentially related to drinking are commonly reported by people with and without HIV (PWH/PWoH). However, the relationship between bothersome symptoms and level of alcohol use is often not appreciated by patients or providers. Therefore, among persons reporting prior-year alcohol use, we assessed whether alcohol use level (AUDIT-C score), HIV status, and demographic covariates influenced the likelihood of the patient reporting a bothersome symptom. We used the Veterans Aging Cohort Study (VACS) surveys (2002-2018), including a validated symptoms index. Among 3679 PWH and 3830 PWoH currently drinking alcohol, the most commonly reported symptoms were muscle/joint pain (52%), sleep disturbance (51%), and fatigue (50%). Level of alcohol use was independently associated with 18 of 20 bothersome symptoms, including seven symptoms more common among PWH. Results can help inform PWH/PWoH who drink alcohol about the strong relationship between level of alcohol use and bothersome symptoms, potentially motivating reduced use.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Research in Addiction Medicine Scholars Program, Boston University Medical Centre, Boston, MA, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Wiliams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
- Yale School of Medicine, 367 Cedar Street, ESH A, suite 401, New Haven, CT, 06510, USA.
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Valente J, Del-Tejo PL, Cubas-Vega NC, Rodrigues MGDA, de Barros FRB, Alexandre MA, Arêas GPT, Bastos M, Pinto SD, Barros CMSS, Marinho EP, Mello S, Ferreira E, Aprigio V, Monte RL, Sampaio V, Lacerda M, Baia-da-Silva DC, Val F. Sequelae and mortality in patients with HIV/AIDS and Progressive Multifocal Leukoencephalopathy: Systematic review and case series in the Brazilian Amazon. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1050477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
BackgroundProgressive Multifocal Leukoencephalopathy (PML) is an opportunistic neurological disease that mainly affects individuals with HIV/AIDS and has high morbidity and mortality, due to its demyelinating characteristic. This co-infection has been reported since the begging of HIV/Aids epidemic with increasing unfavorable outcomes, however, factors associated to sequelae and death are greatly unknown. In this study we aimed to understand factors associated with the main outcomes of individuals diagnosed with PML and HIV/AIDS, in addition to reporting the characteristics of patients presenting to a referral center in infectious diseases in the Brazilian Amazon.MethodsA systematic review was performed until July 2022, following the PRISMA guidelines, at Medline/Pubmed, Web of Science, Lilacs and Scielo databases using combinations of HIV, Aids, JC Virus and Progressive Multifocal Leukoencephalopathy, with no restriction to publication date. Additional cases, meeting the eligibility criteria, were added from our hospital database, which consisted of patients presenting PML/HIV between 2010 and 2022. A meta-analysis aiming to explore factors associated to sequelae and death was performed. Baseline characteristics were described using mean and standard deviation, or median and interquartile range when appropriate; multivariate analysis was performed to study factors associated to death and sequelae outcomes.ResultsEighteen patients were diagnosed between 2010 and 2022, of these, 10 had positive PCR for JC virus. In the Systematic Review, 216 studies yielded 235 confirmed cases of co-infection. A total of 245 were included for analysis. The rates of death and sequelae were, respectively, 47.1% (114/242) and 41.2% (54/131). The use of antiretroviral therapy was more associated with a lower chance of death (OR 0.30, 95% CI: 0.11-0.83), while muscle weakness (OR 4.82, 95% CI: 2.07-11.21) and muscle spasms (OR 6.12, 95% CI: 1.05-35.76) were associated with greater chances of sequelae.ConclusionThose on antiretroviral therapy appear to be less likely to die, and among those who survive, those who have muscle weakness as a symptom on admission are more likely to develop sequelae. Adherence to ART, as well as a comprehensive clinical evaluation and follow-up may help to improve clinical outcomes and awareness of morbidities.
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Siddiqui J, Samuel SK, Hayward B, Wirka KA, Deering KL, Harshaw Q, Phillips A, Harbour M. The economic burden of HIV-associated wasting in the era of modern antiretroviral therapy. J Manag Care Spec Pharm 2022; 28:1180-1189. [DOI: 10.18553/jmcp.2022.22097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mussa FM, Massawe HP, Bhalloo H, Moledina S, Assenga E. Magnitude and associated factors of anti-retroviral therapy adherence among children attending HIV care and treatment clinics in Dar es Salaam, Tanzania. PLoS One 2022; 17:e0275420. [PMID: 36178915 PMCID: PMC9524636 DOI: 10.1371/journal.pone.0275420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The HIV pandemic continues to contribute significantly towards childhood mortality and morbidity. The up-scaling of the Anti-retroviral therapy (ART) access has seen more children surviving and sanctions great effort be made on ensuring adherence. Adherence is a dynamic process that changes over time and is determined by variable factors. This necessitates the urgency to conduct studies to determine the potential factors affecting adherence in our setting and therefore achieve the 90-90-90 goal of sustainable viral suppression. Objectives To assess the magnitude and associated factors of ART adherence among children (1–14 years) attending HIV care and treatment clinics during the months of July to November 2018 in Dar es Salaam. Methods A cross-sectional clinic-based study, conducted in three selected HIV care and treatment clinics in urban Dar es Salaam; Muhimbili National Hospital (MNH), Temeke Regional Referral Hospital (TRRH), Infectious Disease Centre- DarDar Paediatric Program (IDC-DPP) HIV clinics during the months of July to November 2018. HIV-infected children aged 1–14 years who had been on treatment for at least six months were consecutively enrolled until the sample size was achieved. A structured questionnaire was used for data collection. Four-day self-report, one-month self-recall report and missed clinic appointments were used to assess adherence. Frequencies and percentages were used to describe categorical data. The odds ratio was used to analyse the possible factors affecting ART adherence Logistic regression models were used to determine the factors associated with ART adherence. Analysis was conducted using SPSS version 20.0 and p-value <0.05 were considered statistically significant. Results 333 participants were recruited. The overall good adherence (≥95%) was approximated to be 60% (CI-54.3–65.1) when subjected to all three measures. On multivariable logistic regression, factors associated with higher odds of poor adherence were found to be caregivers aged 17–25 years [AOR = 3.5, 95%CI-(1.5–8.4)], children having an inter-current illness [AOR = 10.8, 95%CI-(2.3–50.4)], disbelief in ART effectiveness [AOR = 5.495; 95%CI-(1.669–18.182)] and advanced clinical stage [AOR = 1.972; 95% CI-(1.119–3.484)]. The major reasons reported by caregivers for missing medications included forgetfulness (41%), high pill burden (21%), busy schedule (11%) and long waiting hours at the clinic (9%). Conclusion and recommendations In the urban setting of Dar es Salaam, ART adherence among children was found to be relatively low when combined adherence measures were used. Factors associated with poor ART adherence found were younger aged caregivers, and child intercurrent illness, while factors conferring good adherence were belief in ART effectiveness and lower HIV clinical stage. More attention and support should be given to younger aged caregivers, children with concomitant illness and advanced HIV clinical stages. Educating caregivers on ART effectiveness may also aid in improving adherence.
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Affiliation(s)
- Fatima M. Mussa
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Higgins P. Massawe
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Sibtain Moledina
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
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Gambo A, Gqaleni N. Does <em>Moringa oleifera</em> Lam. leaves supplementation have an impact on the weight and bone mass index of people living with HIV that are on antiretroviral therapy? A double-blind randomized control trial. J Public Health Afr 2022; 13:2126. [PMID: 36277954 PMCID: PMC9585613 DOI: 10.4081/jphia.2022.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background HIV-related weight loss and wasting were the most common malnutrition and AIDS-defining conditions before HAART. HAART has led to more obese PLHIV. HIV-positive patients should eat micro- and macronutrient-rich foods to maintain optimal nutrition. This study examined whether Moringa oleifera Lam. leaf supplementation affects PLHIV receiving ART. Methods A randomized, double-blind, controlled trial was conducted. Two hundred patients with informed consent were randomly assigned to either the Moringa oleifera Lam. (MOG) group or the control group (COG). From baseline to six months of Moringa oleifera Lam. leaf supplementation, anthropometric parameters [weight; BMI] of the participants were assessed. Results One hundred seventy-seven patients completed the 6-month follow-up (89 MOG vs. 88 COG). During the study period, the MOG and COG had similar weights and BMIs (p>0.05). At baseline and six months, most participants in both study groups had a healthy BMI (18.5-24.9). Many participants were overweight; few were underweight ((BMI <18.5). MOG and COG BMI differences at baseline and six months were not significant (p> 0.05). All experiments were 95CI. Conclusions Moringa oleifera Lam. leaf powder had no effect on HIV-positive adults receiving antiretroviral therapy, in accordance with this study.
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Abstract
Cachexia is a complex wasting syndrome, accompanying a variety of end-stage chronic diseases, such as cancer, heart failure and human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). It significantly affects patients' quality of life and survival. Multiple therapeutic approaches have been studied over time. However, despite promising results, no drug has been approved to date. In this review, we examine and discuss the available data on the therapeutic effects of androgens and selective androgen receptor modulators (SARMs) for cachexia.
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Affiliation(s)
- Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100, Milan, Italy; Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100, Milan, Italy; Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, NE1 4LP, UK.
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, NE1 4LP, UK; Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, NE1 3BZ, UK.
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Agordoh PD, Lokpo SY, Owiredu WK, Orish VN, Tettey CO, Sah JA, Kuatsienu LE, Ameke LS, Osei-Yeboah J. Nutritional aberration and related morphological disorders among patients with human immunodeficiency virus infection on combination antiretroviral therapy (cART) in Ghana: A retrospective study. Heliyon 2022; 8:e10436. [PMID: 36090208 PMCID: PMC9449756 DOI: 10.1016/j.heliyon.2022.e10436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/06/2021] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Metabolic and nutritional abnormalities among people living with human immunodeficiency virus (PLHIV) have been reported due to either their HIV infection, primary malnutrition caused by insufficient intake or consequences of the ART regimen provided. This study investigated the prevalence and patterns of nutritional abnormalities including morphological changes among HIV patients under combination Antiretroviral Therapy (cART) in the Bia-West District of the Western North Region. Methods We employed a hospital-based retrospective longitudinal design. Records of 180 patients with HIV infection before and after antiretroviral therapy (ART) initiation were extracted at the Essam Government Hospital. Eligibility criteria included being on treatment without change in regimen for at least one year and without defaulting in scheduled visits. Data extracted included patients' demography, nutritional parameters and medication history. We assessed patients’ nutritional characteristics with the subjective global assessment (SGA) tool which includes five components of medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity & metabolic stress) and two components of physical examination (signs of fat loss and muscle wasting, alterations in fluid balance). Results Malnutrition, lipodystrophy and body wasting among HIV patients were 48.3% (36.5–62.4), 43.9% (32.6–57.7) and 33.3% (23.6–46.0) respectively. Incremental percentage trends of malnutrition (stage I- 7.4%, stage II -22.4%, stage III-24.7%) and lipodystrophy (Stage I - 22.2%, Stage II - 48.7%, Stage III - 51.9%) were significantly associated with worsening disease status. Patients on AZT+3TC + NVP combined regimen presented with the highest malnutrition [52.9% (28.5–76.1)], lipodystrophy [64.7% (38.6–84.7)] and loss of muscle mass [47.1% (23.9–71.5)]. Long-term ART use was significantly associated with high malnutrition rate (p= 0.02620) and increasing muscle mass loss (p = 0.0040). Conclusion High malnutrition, lipodystrophy and muscle wasting exist in PLHIV on cART in the Bia-West District. These adverse nutritional effects may be modulated by disease severity, ARV medication and duration.
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Sindhughosa DA, Somia IKA, Merati KTP, Suryana K. Adjunct Therapy of Zinc Supplementation Increases Immunological Response in HIV-Infected Patients: A Systematic Review and Meta-Analysis. Open AIDS J 2022. [DOI: 10.2174/18746136-v16-e2204120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Malnutrition greatly accelerates the impairment of immune function among HIV-infected patients. Zinc deficiency is often found in people living with HIV/AIDS, affecting their immune function. Several studies have evaluated the effect of zinc in HIV-infected patients, including CD4+ T-cells. However, the results have varied. This review aimed to evaluate the effect of zinc supplementation in HIV patients, particularly its effect on CD4+ T-cells count.
Methods:
Relevant publications were obtained from PubMed database, Google Scholar, COCHRANE, and Science Direct. The primary outcome was CD4+ T-cells count, while the secondary outcomes were viral load and zinc levels. Year of publication, type of study, population, doses of zinc given, duration of zinc administration, sample size, age, and baseline CD4+ T-cells counts were also obtained and reported. Quantitative data from the publications were analyzed using a fixed-effect model or a random-effect model.
Results:
We evaluated 13 full-text articles on zinc supplementation in HIV-infected patients, involving 802 subjects for the experiment group and 742 subjects for the control group. Overall, zinc supplementation, whether as zinc supplementation-only or prepared as multiple micronutrient or multivitamin preparation, increases CD4+ T-cells counts by 33.14 cells/mm3 (p =0.02; 95% CI: 6.09 to 60.19), irrespective of age. Subgroup analysis revealed CD4+ T-cells counts also increase in patients who receive zinc supplementation-only preparation by 33.56 cells/mm3 (p = 0.04; 95% CI: 1.5 to 65.63). Zinc supplementation increases serum zinc levels with pooled mean difference of 15.41 µg/dl (p < 0.05; 95% CI: 12.77 to 18.06). However, the viral load did not significantly decrease with zinc supplementation, with a pooled mean difference of -4.02 copies/ml (p =0.7; 95% CI: -24.78 to 16.75), based on the random-effect model.
Conclusion:
Zinc supplementation in HIV-infected patients enhances immunological response, characterized by an increase in CD4+ T-cells counts. In addition, it increases zinc serum levels in HIV-infected patients, indicating the importance of zinc supplementation in this group of patients.
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Munseri P, Jassely L, Tumaini B, Hertzmark E. Body mass index, proteinuria and total lymphocyte counts in predicting treatment responses among ART naïve individuals with HIV initiated on antiretroviral treatment in Dar es Salaam, Tanzania, 2019: a cohort study. BMJ Open 2022; 12:e059193. [PMID: 35676009 PMCID: PMC9185589 DOI: 10.1136/bmjopen-2021-059193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore the potential use of body mass index (BMI), proteinuria and total lymphocyte count changes in predicting immunological and virological response in individuals with HIV initiated on antiretroviral treatment (ART). DESIGN Prospective cohort study. SETTING Three urban HIV care and treatment centres in Dar es Salaam. PARTICIPANTS Individuals with HIV initiating ART. OUTCOME MEASURES HIV viral load ≥1000 copies/mL (viral non-suppression) at 6 months after ART initiation. RESULTS Of 215 (out of 220 enrolled) participants who returned for evaluation at 6 months, 147 (66.8%) were women. At 6 months of follow-up, 89.4% (76/85) of participants with sustained weight gain were virally suppressed compared with 31.8% (7/22) with sustained loss, p<0.001. In participants who were lymphopaenic at baseline, an increase to normal total lymphocyte counts at 6 months was associated with an increase in CD4 count compared with participants who remained lymphopaenic, 96.2% (50/52) versus 54.8% (17/31), p<0.001. At baseline, 50.0% (110/220) had proteinuria. In participants without proteinuria from baseline to 6 months, 89.8% (79/88) were virally suppressed compared with participants with proteinuria at baseline and/or 3 months, 85.6% (77/90), those with persistent proteinuria, 30.8% (8/26), and proteinuria at 6 months only, 45.5% (5/11), p<0.001. In modified Poisson regression, the independent predictors other than CD4 cell counts for viral non-suppression at 6 months among individuals with HIV initiating on ART were BMI loss >5% from baseline to 6 months (adjusted RR 2.73, 95% CI (1.36 to 5.47)), lymphopaenia at 6 months (adjusted RR=4.54, 95% CI (2.19 to 9.39)) and proteinuria at 6 months (adjusted RR=2.63, 95% CI (1.25 to 5.54)). CONCLUSIONS Change in BMI, total lymphocyte count and presence of proteinuria can monitor and predict ART response and may be particularly helpful in settings when CD4 counts and viral load monitoring are unavailable.
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Affiliation(s)
- Patricia Munseri
- Internal Medicine, Muhimbili University of Health and Allied Sciences School of Medicine, Dar es Salaam, Tanzania
| | - Lazaro Jassely
- Internal Medicine, Muhimbili University of Health and Allied Sciences School of Medicine, Dar es Salaam, Tanzania
| | - Basil Tumaini
- Internal Medicine, Muhimbili University of Health and Allied Sciences School of Medicine, Dar es Salaam, Tanzania
| | - Ellen Hertzmark
- Global Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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El Bouzidi K, Murtala-Ibrahim F, Kwaghe V, Datir RP, Ogbanufe O, Crowell TA, Charurat M, Dakum P, Gupta RK, Ndembi N, Sabin CA. Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005-2017. J Acquir Immune Defic Syndr 2022; 90:88-96. [PMID: 35090157 PMCID: PMC8986580 DOI: 10.1097/qai.0000000000002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). METHODS We conducted a retrospective cohort study of PLHIV aged >15 years who started second-line ART at a tertiary center in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazard models were used to investigate factors associated with: (1) viral failure (HIV-1 RNA >1000 copies/mL), (2) immunologic failure (CD4 count decrease or <100 cells/mm3), and (3) severe weight loss (>10% of bodyweight), after >6 months of second-line ART. RESULTS Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (interquartile range 3.7-8.5). Of these, 26% (89/341) subsequently reentered care. Disengagement was associated with male gender, age <30 years, lower education level, and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared with elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04 to 0.70). CONCLUSION Adverse outcomes were common during second-line ART. However, reengagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and reengage those who have disengaged from care.
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Affiliation(s)
- Kate El Bouzidi
- Division of Infection & Immunity, University College London, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Vivian Kwaghe
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Rawlings P. Datir
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
| | - Obinna Ogbanufe
- U.S. Centers for Disease Control and Prevention, U.S. Embassy, Abuja, Nigeria
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, U.S
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, U.S
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, U.S
| | | | - Ravindra K Gupta
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
- Africa Health Research Institute, Durban, South Africa
| | - Nicaise Ndembi
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, U.S
- Africa Centres for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
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Bolshakova M, Kral AH, Wenger LD, Simpson K, Goldshear J, Sussman S, Bluthenthal RN. Predictors of protein intake among people who inject drugs in Los Angeles and San Francisco, California. Am J Addict 2022; 31:228-235. [PMID: 35315550 PMCID: PMC9117422 DOI: 10.1111/ajad.13280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use. METHODS A cross-sectional design was used to analyze self-reported participant data. PWID were recruited from community settings in California in 2016/2017. Participants reported on food consumption per day for a 30-day period, from which a continuous protein intake variable was created. RESULTS Modal characteristics of participants (N = 937) were: white (42.5%), male (75.3%), healthy body mass index (BMI) (56.6%), and unhoused (82.9%). Less than 1% of participants met or exceeded recommended guidelines for protein intake (0.80 g/day/1 kg body weight). The final multiple regression model found protein intake to be significantly positively associated with older age, high school or greater education, frequency of opiate and marijuana use, while Latinx ethnicity was inversely associated with protein intake, adjusting for gender. DISCUSSION AND CONCLUSIONS Our study shows PWID are generally not underweight, yet they are grossly protein deficient, which can be harder to recognize. Poverty, homelessness, and other structural barriers likely contribute to this issue, which demonstrates the need for communities to provide more access to nutrient-rich food to PWID. SCIENTIFIC SIGNIFICANCE Our study demonstrates the novel findings that opiate and marijuana use frequency, but not stimulants (methamphetamine and cocaine) may increase preference for protein-rich foods among PWID.
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Affiliation(s)
- Maria Bolshakova
- Keck Medicine, Department of Population and Public Health Sciences University of Southern California Los Angeles California USA
| | | | | | - Kelsey Simpson
- Keck Medicine, Department of Population and Public Health Sciences University of Southern California Los Angeles California USA
| | - Jesse Goldshear
- Keck Medicine, Department of Population and Public Health Sciences University of Southern California Los Angeles California USA
| | - Steve Sussman
- Keck Medicine, Department of Population and Public Health Sciences University of Southern California Los Angeles California USA
| | - Ricky N. Bluthenthal
- Keck Medicine, Department of Population and Public Health Sciences University of Southern California Los Angeles California USA
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Pre-Transplant Serum Leptin Levels and Relapse of Acute Myeloid Leukemia after Allogeneic Transplantation. Int J Mol Sci 2022; 23:ijms23042337. [PMID: 35216457 PMCID: PMC8879842 DOI: 10.3390/ijms23042337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Weight loss and metabolic activity influence outcome after allogeneic stem cell transplantation (alloSCT). This study evaluates pre-conditioning Leptin, a peptide hormone involved in metabolism and immune homeostasis, as a prognostic factor for survival, relapse and non-relapse mortality (NRM) following alloSCT. Leptin serum levels prior to conditioning were determined in a cohort of patients transplanted for various hematologic malignancies (n = 524) and correlated retrospectively with clinical outcome. Findings related to patients with acute leukemia (AL) from this sample were validated in an independent cohort. Low pre-conditioning serum Leptin was an independent prognostic marker for increased risk of relapse (but not of NRM and overall mortality) following alloSCT for AL of intermediate and advanced stage (beyond first complete remission). Multivariate analysis revealed a hazard ratio (HR) for relapse of 0.75 per log2 increase (0.59–0.96, p = 0.020). This effect was similar in an independent validation cohort. Pre-conditioning serum Leptin was validated as a prognostic marker for early relapse by fitting the multivariate Cox model to the validation data. Pre-conditioning serum Leptin levels may serve as an independent prognostic marker for relapse following alloSCT in intermediate and advanced stage AL patients. Prospective studies are required to prove whether serum Leptin could be used for guiding nutritional intervention in patients with AL undergoing alloSCT.
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Alebel A, Demant D, Petrucka PM, Sibbritt D. Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis. BMJ Open 2022; 12:e055266. [PMID: 35105589 PMCID: PMC8808440 DOI: 10.1136/bmjopen-2021-055266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The first objective was to explore weight change in the first 2 years after antiretroviral therapy (ART) initiation in adults living with HIV. The second objective was to identify the predictors of weight change over time among adults living with HIV on ART. DESIGN An institution-based retrospective longitudinal study was conducted. SETTING The study was conducted at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. PARTICIPANTS The study included 848 randomly selected medical charts of adults living with HIV receiving ART between June 2014 and June 2020. PRIMARY AND SECONDARY OUTCOMES The primary outcome was weight change in the first 2 years after ART initiation. The secondary outcome was to identify predictors of weight change. Association between predictor variables and weight change was assessed using an LMM. Variables with p values <0.05 in the final model were considered as statistically significant predictors of weight change. RESULTS Of 844 study participants, more than half (n=499; 58.8%) were female. Participants' mean weight increased from 54.2 kg (SD ±9.6 kg) at baseline to 59.5 kg (SD ±10.7 kg) at the end of follow-up. Duration of time on ART, sex, WHO clinical disease staging, functional status, nutritional status and presence of opportunistic infections were significant predictors of weight change at ART initiation. Significant interaction effects were observed between time and sex, WHO clinical disease staging, functional status, isoniazid preventive therapy and nutritional status. CONCLUSION We found a linear increment of weight over 24 months of follow-up. Rate of weight gain over time was lower in patients with advanced disease stage and working functional status, whereas weight gain rate was higher in male and underweight patients.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Pammla Margaret Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Antonini M, Gerin L, Melo ES, Pontes PS, Arantes LMN, Ferreira GRON, Reis RK. PREVALENCE AND FACTORS ASSOCIATED WITH LATE DIAGNOSIS OF THE HIV INFECTION IN A MUNICIPALITY OF SÃO PAULO. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2020-0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify the prevalence and factors associated with late diagnosis of the infection by the Human Immunodeficiency Virus (HIV), in a municipality of São Paulo. Method: an epidemiological, analytical and retrospective study that analyzed the HIV and AIDS cases notified by the health services in the period from 2015 to 2017 using data from the notifications of the Information System for Notifiable Diseases (SINAN Net) corresponding to the users recently diagnosed with HIV/AIDS infection in the municipality of Ribeirão Preto/SP, Brazil. Data collection was in May 2018. The chi-square test was performed, as well as binary logistic regression, where the dependent variable was the AIDS criterion at the moment of notifying infection by HIV. A p-value<0.05 was considered for the association between the variables studied in relation to late diagnosis. Results: of the 829 (100%) new HIV cases, 290 (35.0%) were diagnosed in the condition of AIDS. Most of the population was male and aged between 15 and 34 years old. Oral candidiasis and weight loss greater than 10% were the main symptoms associated with AIDS. It was observed that people with lower schooling levels and older were more prone to late diagnoses. Conclusion: it is necessary to devise strategies that favor timely diagnosis in the municipality under study, particularly among the individuals aged over 45 years old and with lower schooling levels.
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Affiliation(s)
| | - Larissa Gerin
- Universidade de São Paulo, Brasil; Secretaria Municipal de Saúde de Ribeirão Preto, Brasil
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Siddiqui J, Samuel SK, Hayward B, Wirka KA, Deering KL, Harshaw Q, Phillips A, Harbour M. HIV-associated wasting prevalence in the era of modern antiretroviral therapy. AIDS 2022; 36:127-135. [PMID: 34628440 PMCID: PMC8654247 DOI: 10.1097/qad.0000000000003096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the prevalence of HIV-associated wasting (HIVAW) in the United States. DESIGN Medical and pharmacy claims study using IBM MarketScan Commercial, Medicare Supplemental and Medicaid Databases. METHODS Study period: July 2012-September 2018 (first HIV diagnosis claim = HIV index date). People with HIV (PWH) were excluded if they were aged less than 18 years, had any malignancy claim or had less than 6 months of enrollment data pre or post-HIV index date. HIVAW was defined by proxy using claims for weight loss-related diagnoses, appetite stimulant/nontestosterone anabolic agents or enteral/parenteral nutrition. Prevalence was reported cumulatively, by insurance type and antiretroviral therapy (ART) pharmacy claims (defined as ≥1 pharmacy claim of any ART within 12 months post-HIV index date). Statistical analysis assessed factors potentially associated with HIVAW. RESULTS The study population comprised 42 587 PWH (64.6% male, mean age 44 years, 67.5% on Medicaid, 63.9% on ART). Cumulative HIVAW prevalence (2012-2018) was 18.3% (n = 7804) for all PWH (17.9% on ART, 19.1% not on ART). HIVAW prevalence by payer was 7.5% for Commercial and Medicare Supplemental and 23.5% for Medicaid. The strongest associations with the likelihood of meeting the definition of HIVAW were for individuals with Medicaid and hospitalization(s) post-HIV index date; race and ART status were not associated. CONCLUSIONS Findings suggest HIVAW remains prevalent in PWH. ART use was not found to be associated with HIVAW. HIVAW was highest among those with Medicaid coverage or any hospitalization(s). Further research is needed to better understand additional factors associated with and contributing to HIVAW.
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Affiliation(s)
| | - Shanti K. Samuel
- EMD Serono, Inc., Rockland, Massachusetts, USA, an affiliate of Merck KGaA
| | - Brooke Hayward
- EMD Serono, Inc., Rockland, Massachusetts, USA, an affiliate of Merck KGaA
| | - Kelly A. Wirka
- EMD Serono, Inc., Rockland, Massachusetts, USA, an affiliate of Merck KGaA
| | | | | | - Amy Phillips
- EMD Serono, Inc., Rockland, Massachusetts, USA, an affiliate of Merck KGaA
| | - Michael Harbour
- EMD Serono, Inc., Rockland, Massachusetts, USA, an affiliate of Merck KGaA
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Carpenter CL, Kapur K, Ramakrishna P, Pamujula S, Yadav K, Giovanni JE, Julian O, Ekstrand ML, Sinha S, Nyamathi AM. Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up. Nutrients 2021; 14:179. [PMID: 35011054 PMCID: PMC8746930 DOI: 10.3390/nu14010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.
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Affiliation(s)
| | | | | | - Suresh Pamujula
- People’s Health Society, Nellore 524137, India; (P.R.); (S.P.)
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
| | - Jennifer E. Giovanni
- Center for Human Nutrition, University of California, Los Angeles, CA 90024, USA;
| | - Olivia Julian
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA;
| | - Maria L. Ekstrand
- Center for AIDS Prevention, Department of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Sanjeev Sinha
- All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
| | - Adeline M. Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
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Tekelehaimanot AN, Lemma TB, Gudina EK, Getnet M, Amdisa D, Dadi LS. Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study. J Int Assoc Provid AIDS Care 2021; 19:2325958220976254. [PMID: 33297825 PMCID: PMC7734494 DOI: 10.1177/2325958220976254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: The study aimed to see predictors of undernourished and its implication towards HIV continuum care. Study Design: unmatched case-control study was conducted among 678 individuals in Jimma zone, southwest Ethiopia. Methods: Randomly selected data of 339 PLWHA who had poor nutritional outcomes (cases) and 339 without undernourished (controls) were analyzed. Logistic regression was used to identify forecasters of undernutrition. The quantitative results were supplemented from key informants who work closely on HIV care, then data were coded and analyzed thematically. Results: Rural residence (AOR:1.8; 95% CI: 1.2, 6.4), female (AOR: 2.9; 95% CI: 1.1, 4.3), unstable livelihood (AOR: 5.1; 95% CI: 4.2, 19.6), low meal frequency (AOR: 6.6; 95% CI: 5.2, 21.1), less diversified foods (AOR: 3.5; 95% CI: 1.2, 14.3), and advanced WHO clinical stage (AOR: 4.3; 95% CI: 3.6, 13.7) and were found to be independent predictors of undernourishment. No social support advanced clinical stage, and unstable livelihood adversely affect nutritional status of PLWHA from the qualitative data. Conclusions: The socio-cultural, economic, and health-system factors inhibit ideal patient nutritional status. Better tracking, enhanced livelihood and social support along with drug therapy, food aid needs to consider for PLWHA.
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Affiliation(s)
| | | | | | - Masrie Getnet
- Faculty of Public Health, 107839Jimma University, Jimma, Ethiopia
| | - Demuma Amdisa
- Faculty of Public Health, 107839Jimma University, Jimma, Ethiopia
| | - Lelisa Sena Dadi
- Faculty of Public Health, 107839Jimma University, Jimma, Ethiopia
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Osuna-Padilla IA, Salazar Arenas MDLA, Rodríguez-Moguel NC, Aguilar-Vargas A, Montano Rivas JA, Ávila-Ríos S. Phase angle as predictor of malnutrition in people living with HIV/AIDS. Nutr Clin Pract 2021; 37:146-152. [PMID: 34270135 DOI: 10.1002/ncp.10744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.
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Affiliation(s)
- Iván Armando Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | - Adriana Aguilar-Vargas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Sall I, Diatta JP, Faye K, Cisse O, Sall F, Guèye NFN, Ndour CT, Sow PS, Malomar JJ, Hawes SE, Seydi M, Gottlieb GS. The impact of food insecurity on HIV outcomes in Senegal, West Africa: a prospective longitudinal study. BMC Public Health 2021; 21:451. [PMID: 33676463 PMCID: PMC7936446 DOI: 10.1186/s12889-021-10444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa. Methods HIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes. Results Among the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30–240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 [1.08–9.06]) and persistent severe food insecurity was associated with virologic failure (OR 5.14 [1.01–26.29]) and poor adherence to ART 8.00 [1.11–57.57]. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 [1.56–11.47]), virologic failure (OR 3.39 [1.13–10.21]), and death (OR 3.35 [1.40–8.03]). Conclusion Severity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10444-1.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Ndèye Fatou Ngom Guèye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Tekelehaimanot AN, Belachew T, Gudina EK, Getnet M, Amdisa D, Dadi LS. Intention Toward Dietary Diversity Among Adult People Living With HIV in Public Hospitals in Southwest Ethiopia Using Theory of Planned Behavior. A Mixed Methods Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060805. [PMID: 34930043 PMCID: PMC8721683 DOI: 10.1177/00469580211060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dietary diversity is a crucial element of an inclusive care for people living with HIV (PLWHIV), particularly in resource-limited countries where undernutrition, poor intention, and poor attitude toward diversified diets are the common challenges. The aim of this study was to assess the Intention toward dietary diversity behavior among adult PLWHIV in Jimma zone public hospitals, South West Ethiopia. A hospital-based survey was carried out in 5 public institutions among sampled 403 adult PLWHIV. Data were entered into EpiData, and exported to SPSS version 20 for analysis. Relationships among variables were assessed using correlation coefficients. The multivariable linear regression model was fitted to assess predictors of behavioral inclination toward dietary diversity at P-value ≤ .05. The quantitative data was supplemented by qualitative data, which was collected through key informant interviews and analyzed thematically. The significant predictors of intention to use dietary diversity were attitude (β = .196, P < .01) and subjective norm (β = .390, P < .01) of adult PLWHIV. The constructs of theory of planned behavior (TPB) independently explained the variance in inclination toward dietary diversity by 25.7%. All the intermediate, proximal, and distal components of TPB explained the final model with 32.2% of variance in the intention to use dietary diversity. The qualitative findings indicated that delivery of HIV care requires a drive for livelihood development and economic improvement, creating a sense of responsibility for sustainable HIV care by creating behavioral change at the individual level. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition.
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Affiliation(s)
| | - Tefera Belachew
- Department of Population and Family health, Faculty of Public Health, Jimma University, Ethiopia
| | - Esayas Kebede Gudina
- Departments of Internal Medicine, Jimma Medical Center, Jimma University, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Ethiopia
| | - Demuma Amdisa
- Department of Health Behavior and Society, Faculty of Public Health, Jimma University, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Ethiopia
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Lane C, Adair L, Bobrow E, Ndayisaba GF, Asiimwe A, Mugwaneza P. Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda. Ann Epidemiol 2021; 53:1-6.e1. [PMID: 32805400 PMCID: PMC7747133 DOI: 10.1016/j.annepidem.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/28/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU. METHODS The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO. RESULTS Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ. CONCLUSION There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.
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Affiliation(s)
- Charlotte Lane
- Nutrition Department, University of North Carolina at Chapel Hill, Chapel Hill.
| | - Linda Adair
- Nutrition Department, University of North Carolina at Chapel Hill, Chapel Hill
| | - Emily Bobrow
- Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda
| | | | - Anita Asiimwe
- Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda
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Ahmadinejad M, Karimi-Aliabadi H, Dehghan M, Mangolian P, Tajoddini S. Higher Morbidity and Mortality in Trauma Intensive Care Unit Patients with Opium Addiction. ADDICTION & HEALTH 2021; 13:1-8. [PMID: 33995954 PMCID: PMC8080177 DOI: 10.22122/ahj.v13i1.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Opium addiction is associated with multiple physical, psychological, and social problems. The aim of this study was to compare the risk of morbidity and mortality in opium-addicted and non-addicted trauma patients admitted to the intensive care units (ICUs) of trauma center of Kerman Province, Iran. METHODS In this cohort study, a total of 200 addict and non-addicted patients who were admitted due to trauma in ICUs of Shahid Bahonar Hospital in Kerman during 9 months of 2018 were included. Patients were compared in terms of mortality, incidence of pressure ulcers, incidence of organ failure, duration of mechanical ventilation, and duration of hospitalization. Data were analysed using Fisher's exact test and independent t-test at P < 0.05. FINDINGS Out of 197 examined patients, 161 (81.7%) individuals were men and 36 (18.3%) were women. Moreover, 98 (49.7%) patients had a history of opium abuse, while 99 (50.2%) patients had no history of opium addiction. The addicted and non-addicted groups had no significant differences in terms of age (P = 0.650) and gender (P = 0.580). In addicted patients, mortality, duration of mechanical ventilation (P = 0.027), the incidence of pressure ulcer, and organ failure were significantly higher (P < 0.001), but mean ICU stay and hospitalization time was the same in both groups. CONCLUSION The results of this study indicated higher mortality and morbidity in opium-addicted patients admitted to ICU than non-addicted ones. This suggests that various systems of the body are affected by opium and, in certain circumstances such as severe diseases, this will cause problems for patients. Therefore, experts should pay attention to complications and side effects of addiction in the management of critical patients with a history of opium abuse.
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Affiliation(s)
- Mehdi Ahmadinejad
- Neuroscience Research Center, Institute of Nuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hakimeh Karimi-Aliabadi
- Neuroscience Research Center, Institute of Nuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrad Tajoddini
- Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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30
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Abstract
Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.
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Affiliation(s)
- Liyanage Ashanthi Menaka Perera
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, 1000 First Drive NW, Austin, Minnesota, 55912, USA
| | - Aparna Chopra
- Institute for Critical Care Medicine, The Mount Sinai Hospital, 1468 Madison Avenue, Guggenheim Pavilion 6 East, Room 378, New York, New York, USA
| | - Amy L Shaw
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68th Street, Box 39, New York, NY 10065, USA.
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31
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Markos M, Lolaso T, Mengistu A, Tariku Z. Dietary Diversity and Associated Factors Among Adult HIV Positive Patients on Anti-Retroviral Therapy in Public Hospitals of Kembata Tembaro Zone, Southern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:859-868. [PMID: 33304109 PMCID: PMC7723228 DOI: 10.2147/hiv.s278855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022]
Abstract
Background Nutrition is a significant factor in all stages of HIV. Dietary management of HIV-positive patients is key to supporting their capacity to continue participating in the workforce and contributing to socio-economic growth. Few studies have been conducted regarding this important public health problem of dietary diversity throughout the developing countries including Ethiopia. Therefore, this study assesses the magnitude and factors associated with dietary diversity among HIV-positive patients attending antiretroviral therapy (ART) clinics at Public Hospitals in Kembata Tembaro Zoni, Southern Ethiopia. Methods and Materials An institutional-based cross-sectional study was conducted from January 01/2019 to 30/2019 on 341 adult HIV-positive patients on ART at two randomly selected public hospitals in the study area. A systematic random sampling technique was applied to select study subjects from each facility proportionally. Bivariable and multivariable logistic regression analyses were done to identify factors associated with individual dietary diversity. Logistic regression analysis with 95% confidence interval (CI) was estimated to measure the strength of association. Level of significance for statistical tests was set at p <0.05. Results This study shows 60.1% (95% CI: 55–65) of patients had inadequate dietary diversity. Average monthly income of less than 1000 Ethiopian Birr (AOR: 1.82, 95% CI: 1.04–3.17), being female (AOR = 2.99, 95% CI: 1.67–5.37), duration of ART less than 1 year (AOR = 3.77, 95% CI: 1.42–10.02) and lack of dietary counseling (AOR =0.54, 95% CI: 0.30–0.97) were factors associated with low dietary diversity. Conclusion Low dietary diversity was a major nutritional problem in HIV-positive patients. Low average monthly income, being female, duration of participants on ART, and lack of dietary counseling were the factors associated with low dietary diversity. To alleviate these problems, exceptional attention in nutritional care should be given to HIV-positive patients and they require appropriate counseling and support during early initiation of ART.
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Affiliation(s)
- Melese Markos
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tsegaye Lolaso
- School of Public Health, College of Health and Medicine Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abrham Mengistu
- Department of Public Health, College of Health and Medicine Science, Wachamo University, Hossaina, Ethiopia
| | - Zerihun Tariku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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32
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Weldesenbet AB, Ayele TA, Sisay MM, Tusa BS, Kebede SA. Predictors of Change in Weight Among People Living with HIV on Antiretroviral Treatment in West Hararghe Zone, Ethiopia: A Retrospective Longitudinal Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:373-380. [PMID: 32903898 PMCID: PMC7445526 DOI: 10.2147/hiv.s262663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
Background Human immunodeficiency virus (HIV) remains a major global public health issue, particularly in Africa. In resource-limited settings like Ethiopia, regular weight measurement and monitoring is useful in the examination of patient response to antiretroviral therapy and in clinical decision-making. However, there is a paucity of evidence on factors that affect longitudinal weight change. Therefore, the present study was intended to identify predictors of weight change among people living with HIV (PLWH) in West Hararghe, Ethiopia. Methods An institutional-based retrospective cohort study was conducted among 558 PLWH aged 18 years and above from September 2013 to January 2019 at Chiro Zonal Hospital and Gelemso General Hospital in West Hararghe zone, Ethiopia. Data were entered in Epi info 7 and analyzed in R software. The linear mixed effect regression model was used to identify predictors of longitudinal change in weight. Regression coefficients with their 95% confidence intervals were used to indicate the strength and significance of the association. Results Weight showed improvement in follow-up periods. In this study, age of respondent (beta=0.136, 95% CI, 0.044:0.227), time since the initiation of antiretroviral therapy (ART) (beta=0.089, 95% CI, 0.075:0.104), primary educational status (beta=2.403, 95% CI, 0.540:4.266), secondary educational status (beta=4.035, 95% CI, 1.666:6.404), tertiary and above educational status (beta=3.444, 95% CI, 0.330:6.558), sex (beta= −5.514, 95% CI, -7.260:-3.768), ambulatory functional status (beta= −3.419, 95% CI, −6.169:-0.668) and baseline CD4 count (≤200) (beta=2.205, 95% CI, 0.593, 3.817) were significant predictors of longitudinal weight change. Conclusion We observed an increment in weight among PLWH who were on ART in Ethiopia. Educational status, time since the beginning of ART, age and having CD4 count above 200 have contributed positively to the change in weight, while ambulatory functional status and being female are negatively associated with longitudinal change in weight. Close monitoring is recommended for patients with ambulatory baseline functional status and for patients with baseline CD4 count ≤200.
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Affiliation(s)
- Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Khatri S, Amatya A, Shrestha B. Nutritional status and the associated factors among people living with HIV: an evidence from cross-sectional survey in hospital based antiretroviral therapy site in Kathmandu, Nepal. BMC Nutr 2020; 6:22. [PMID: 32549993 PMCID: PMC7294605 DOI: 10.1186/s40795-020-00346-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors. METHODS A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index < 18.5 kg/m2) and overweight/obesity (body mass index > 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score. RESULTS The prevalence of underweight was found to be 18.3% (95% CI: 14.3-22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%). CONCLUSION Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants.
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Affiliation(s)
- Samip Khatri
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Archana Amatya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Binjwala Shrestha
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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Satre DD, Sarovar V, Leyden W, Hare CB, Catz SL, Bryant KJ, Williams EC, Hojilla JC, Horberg MA, Silverberg MJ. Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data. AIDS Behav 2020; 24:1784-1792. [PMID: 31773444 DOI: 10.1007/s10461-019-02742-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a sample of people with HIV (PWH) enrolled in an alcohol intervention trial and followed for 12 months, we examined the association of changes in days (i.e., decrease, increase, no change [reference]) of unhealthy drinking (consuming ≥ 4/≥ 5 drinks for women/men) with antiretroviral therapy adherence (≥ 95% adherent), viral suppression (HIV RNA < 75 copies/mL), condomless sex with HIV-negative/unknown status partners, and dual-risk outcome (HIV RNA ≥ 75 copies/mL plus condomless sex). The sample included 566 PWH (96.8% male; 63.1% White; 93.9% HIV RNA < 75 copies/mL) who completed baseline, 6-, and 12-month assessments. Decrease in days of unhealthy drinking was associated with increased likelihood of viral suppression (odds ratio [OR] 3.78; 95% confidence interval [CI] 1.06, 13.51, P = .04) versus no change. Increase in days of unhealthy drinking was associated with increased likelihood of condomless sex (OR 3.13; 95% CI 1.60, 6.12, P < .001). Neither increase nor decrease were associated with adherence or dual-risk outcome. On a continuous scale, for each increase by 1 day of unhealthy drinking in the prior month, the odds of being 95% adherent decreased by 6% (OR 0.94, 95% CI 0.88, 1.00, P = 0.04).
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Affiliation(s)
- Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Charles B Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
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Foreman SC, Wu PH, Kuang R, John MD, Tien PC, Link TM, Krug R, Kazakia GJ. Factors associated with bone microstructural alterations assessed by HR-pQCT in long-term HIV-infected individuals. Bone 2020; 133:115210. [PMID: 31874226 DOI: 10.1016/j.bone.2019.115210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE In adults with long-term HIV infection, low bone density and increased fracture risk have emerged as significant comorbidities. Our aim was to assess the association of exercise, nutrition, and medications with bone quality in adults with long-term HIV infection. METHODS Forty-three adults with HIV infection were enrolled (median BMI 25.7, range 18.2-35.6 kg/m2; median age 57, range 50-69 years). Participants underwent ultradistal radius and tibia high-resolution peripheral quantitative CT (HR-pQCT). Questionnaires included the revised Community Healthy Activities Model Program for Seniors (CHAMPS), the Mini Nutritional Assessment (MNA) as well as medication assessments. Multivariable linear regression models were used to evaluate the association of exercise, nutritional status, tenofovir disoproxil fumarate (TDF) and protease inhibitor (PI) use with bone density and microstructure, adjusting for demographic risk factors. RESULTS In regression models, higher nutrition scores were associated with higher tibia cortical thickness (R2 = 0.23; β = 0.03; p = 0.044) and higher radius cortical BMD (R2 = 0.43; β = 8.4; p = 0.026). Higher weekly frequency of all physical activities was significantly associated with higher radius trabecular BMD (R2 = 0.38; β = 0.96; p = 0.050), higher radius trabecular number (R2 = 0.31; β = 0.01; p = 0.026), lower tibia and radius trabecular separation (tibia: R2 = 0.30; β = -0.003; p = 0.038; radius: R2 = 0.35; β = -0.003; p = 0.021), and higher radius bone stiffness (R2 = 0.45; β = 0.38; p = 0.047). Higher frequency of bone loading physical activities was significantly associated with higher tibia trabecular density (R2 = 0.44; β = 4.06; p = 0.036), higher tibia bone stiffness (R2 = 0.46; β = 3.06; p = 0.050), and higher tibia estimated failure load (R2 = 0.46; β = 0.17; p = 0.049). TDF used in combination with a PI was associated with lower radius trabecular BMD (R2 = 0.39; β = -41.2; p = 0.042), lower radius trabecular number (R2 = 0.34; β = -0.44; p = 0.009) and greater radius trabecular separation (R2 = 0.42; β = 0.16; p = 0.002), while TDF use without a PI was not associated with reduced bone quality. CONCLUSIONS In adults with HIV infection, malnutrition is associated with poor cortical bone quality, while reduced frequency of physical activities and specifically reduced frequency of mechanical loading activities are associated with deficient trabecular bone structure and reduced estimates of bone strength. TDF use in combination with a PI is associated with deleterious effects on trabecular bone structure.
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Affiliation(s)
- Sarah C Foreman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA; Department of Radiology, Technical University of Munich, Germany
| | - Po Hung Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA
| | - Ruby Kuang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA
| | - Malcolm D John
- Department of Medicine, University of California, San Francisco, 4150 Clement St, Rm 111W, San Francisco, CA 94121, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, 4150 Clement St, Rm 111W, San Francisco, CA 94121, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA.
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Odwee A, Kasozi KI, Acup CA, Kyamanywa P, Ssebuufu R, Obura R, Agaba JB, Makeri D, Kirimuhuzya C, Sasirabo O, Bamaiyi PH. Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda. Afr Health Sci 2020; 20:122-131. [PMID: 33402900 PMCID: PMC7750061 DOI: 10.4314/ahs.v20i1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients. METHODS A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors. RESULTS The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition. DISCUSSION In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities. CONCLUSIONS Malnutrition is a threat in HIV adult patients in rural communities of Uganda.
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Affiliation(s)
- Ambrose Odwee
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Christine Amongi Acup
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Richard Obura
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Jude B Agaba
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Danladi Makeri
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology, School of Pharmacy, Kampala International University Western Campus, Box 71 Bushenyi, Uganda
- Department of Pharmacology, School of Medicine, Kabale University, Kabale, Uganda
| | - Olivia Sasirabo
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Pwaveno H Bamaiyi
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Postgraduate School and Research Directorate, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Jos, Plateau State, Nigeria
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Connor KL, Kibschull M, Matysiak-Zablocki E, Nguyen TTTN, Matthews SG, Lye SJ, Bloise E. Maternal malnutrition impacts placental morphology and transporter expression: an origin for poor offspring growth. J Nutr Biochem 2020; 78:108329. [PMID: 32004932 DOI: 10.1016/j.jnutbio.2019.108329] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
The placenta promotes fetal growth through nutrient transfer and selective barrier systems. An optimally developed placenta can adapt to changes in the pregnancy environment, buffering the fetus from adverse exposures. We hypothesized that the placenta adapts differently to suboptimal maternal diets, evidenced by changes in placental morphology, developmental markers and key transport systems. Mice were fed a control diet (CON) during pregnancy, undernourished (UN) by 30% of control intake from gestational day (GD) 5.5-18.5 or fed 60% high-fat diet (HF) 8 weeks before and during pregnancy. At GD18.5, placental morphometry, development and transport were assessed. Junctional and labyrinthine areas of UN and HF placentae were smaller than CON by >10%. Fetal blood space area and fetal blood space:fetal weight ratios were reduced in HF vs. CON and UN. Trophoblast giant cell marker Ctsq mRNA expression was lower in UN vs. HF, and expression of glycogen cell markers Cx31.1 and Pcdh12 was lower in HF vs. UN. Efflux transporter Abcb1a mRNA expression was lower in HF vs. UN, and Abcg2 expression was lower in UN vs. HF. mRNA expression of fatty acid binding protein Fabppm was higher in UN vs. CON and HF. mRNA and protein levels of the lipid transporter FAT/CD36 were lower in UN, and FATP4 protein levels were lower in HF vs. UN. UN placentae appear less mature with aberrant transport, whereas HF placentae adapt to excessive nutrient supply. Understanding placental adaptations to common nutritional adversities may reveal mechanisms underlying the developmental origins of later disease.
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Affiliation(s)
- Kristin L Connor
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Health Sciences, Carleton University, Ottawa, Ontario, Canada.
| | - Mark Kibschull
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | - Stephen G Matthews
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Lye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Enrrico Bloise
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Spencer DC, Krause R, Rossouw T, Moosa MYS, Browde S, Maramba E, Jankelowitz L, Mulaudzi MB, Ratishikana-Moloko M, Modupe OF, Mahomed A. Palliative care guidelines for the management of HIV-infected people in South Africa. South Afr J HIV Med 2019; 20:1013. [PMID: 31956436 PMCID: PMC6956685 DOI: 10.4102/sajhivmed.v20i1.1013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/01/2022] Open
Affiliation(s)
- David C Spencer
- Division of Infectious Diseases, Department of Medicine, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - René Krause
- Department of Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Selma Browde
- Community Action NGO/NPO, Johannesburg, South Africa
| | - Esnath Maramba
- Clinical Unit, Council for Medical Schemes, Pretoria, South Africa
| | | | | | - Mpho Ratishikana-Moloko
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Adam Mahomed
- Department of Internal Medicine, Charlotte Maxake Johannesburg Academic Hospital, Johannesburg, South Africa
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Sookan T, Motala A, Ormsbee M, Antonio J, Magula N, Lalloo U, McKune A. Improvement in Muscular Strength in HIV-Infected Individuals Receiving Antiretroviral Therapy. J Funct Morphol Kinesiol 2019; 4:E66. [PMID: 33467381 PMCID: PMC7739231 DOI: 10.3390/jfmk4030066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study investigated (1) the effect of a progressive resistance training (PRT) program and whey protein intake on maximal muscle strength in human immunodeficiency virus (HIV)-infected individuals receiving antiretroviral therapy (ART) and (2) alterations in maximal strength 12 wks after the cessation of PRT with continued supplementation. METHODS Sixty HIV-infected individuals were recruited. Whole body PRT was performed twice weekly for 12 wks. Participants received, in a double-blind placebo controlled manner, either 20 g whey or placebo (maltodextrin) before and immediately after each session. Both PRT groups continued to take either whey protein or placebo for a further 12 wks following the exercise intervention to examine the effects of detraining. RESULTS Forty participants (mean and standard deviation (SD) age 40.8 (±7.7) years, weight 70.8 (±16) kg, body mass index (BMI) 30.9 (±7.2) kg m2); whey protein /PRT (n = 13), placebo/PRT (n = 17), and a control group (n = 10) completed the study. A significant main effect for time occurred for the bench press (p = 0.02), the squat (p < 0.0001), the deadlift (p = 0.001) and the shoulder press (p = 0.02) one-repetition maximum (1RM) in the intervention groups. CONCLUSION The PRT program increased maximal strength regardless of whey protein intake. The detraining period demonstrated minimal strength loss, which is beneficial to this population.
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Affiliation(s)
- Takshita Sookan
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
| | - Ayesha Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Michael Ormsbee
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
- Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Jose Antonio
- Exercise and Sport Science, Nova Southeastern University, Davie FL 33328, USA;
| | - Nombulelo Magula
- Department of Internal Medicine Durban, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Umesh Lalloo
- Department of Pulmonology Durban, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Andrew McKune
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
- Discipline of Sport and Exercise Science, University of Canberra, Canberra 2617, Australia
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Okello S, Kim JH, Sentongo RN, Tracy R, Tsai AC, Kakuhikire B, Siedner MJ. Blood pressure trajectories and the mediated effects of body mass index and HIV-related inflammation in a mixed cohort of people with and without HIV in rural Uganda. J Clin Hypertens (Greenwich) 2019; 21:1230-1241. [PMID: 31278845 DOI: 10.1111/jch.13621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022]
Abstract
We sought to describe changes in blood pressure and estimate the effect of HIV on blood pressure (BP) over 4 years of observation in a cohort of 155 HIV-infected adults (≥40 years) on antiretroviral therapy (ART) and 154 sex- and age-quartile-matched, population-based, HIV-uninfected controls for four years in rural Uganda, we compared changes in blood pressure (BP) by HIV serostatus and tested whether body mass index and inflammation (high-sensitivity C-reactive protein and interleukin-6) and immune activation (sCD14 and sCD163) mediated the effects of HIV on BP using hierarchical multivariate and two-stage parametric regression models. Overall HIV-uninfected participants had higher mean BP than HIV-infected counterparts (differences in trend P < 0.0001 for diastolic BP and P = 0.164 for systolic BP). After initial declines in BP in both groups between years 1 and 2, BP moderately increased in both groups through year 4, with greater change over time observed in the HIV-uninfected group. Body mass index mediated 72% (95%CI 57, 97) of the association between HIV and systolic BP. We found a minimal mediating effect of sCD14 on the relationship between HIV and SBP (9%, 95% CI 5%, 21%), but found no association between other HIV-related biomarkers. Over four years of observation, HIV-infected people in rural Uganda have lower BP than HIV-uninfected counterparts despite having higher levels of inflammation. BMI, rather than measures of HIV-associated inflammation, explained a majority of the difference in BP observed.
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Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia, USA.,Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - June-Ho Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ruth N Sentongo
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Alexander C Tsai
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard Kakuhikire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Human Resource Management, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Zemede Z, Tariku B, Kote M, Estifanos W. Undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in the Arba Minch area, southern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:147-154. [PMID: 31308761 PMCID: PMC6613366 DOI: 10.2147/hiv.s200120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
Abstract
Background: Undernutrition constitutes an important threat to the success of HIV programs in sub-Saharan Africa, and failure to effectively address it may jeopardize the benefits gained so far in the fight against HIV. The aim of the study was to assess undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in Arba Minch area, south Ethiopia. Methods: A facility-based cross-sectional study was conducted in 2017. There were 351 adult individual study participants who were enrolled in ART clinics in Arba Minch area public health facilities. Variables with P-value less than 0.25 on binary logistic regression analysis were entered into a multivariate logistic regression model to outline the independent predictors of undernutrition. CI of 95% was used to assess precision of the study. Results: Out of all the participants, 18.23% (95% CI: 14.52–22.65) were undernourished. The prevalence of undernutrition was significantly lower among those consuming food from five or more food groups per day (AOR: 0.33; 95% CI: 0.16–0.71) and undergoing ART for more than a year (AOR: 0.24; 95% CI: 0.08–0.73). On the contrary, the prevalence was significantly higher among those who were currently smoking tobacco (AOR: 6.67; 95% CI: 1.45–30.76). In addition, those with WHO clinical stage 3 had a significantly higher prevalence of undernutrition compared to those with WHO clinical stage 1 (AOR: 311; 95% CI: 1.47–6.60). Conclusion: The prevalence of undernutrition was high among adults with HIV/AIDS enrolled in ART clinics in the study area. The prevalence of undernutrition was lower among those who consumed diverse food groups and had been receiving ART for longer (more than a year).
On the contrary, the prevalence of undernutrition was higher among those who consumed tobacco and with higher WHO clinical stage. Therefore, efforts should be made to enhance the dietary diversity of these individuals.
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Affiliation(s)
- Zale Zemede
- Arba Minch Zuria District Health Office , Arba Minch, Ethiopia
| | - Befikadu Tariku
- Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Mesfin Kote
- Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
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Bhima K, Mtimuni B, Matumba L. Tackling protein-energy under-nutrition among resource-limited people living with HIV/AIDS in Malawi using soybean-enriched maize-based stiff porridge (nsima): A pilot study. Nutr Diet 2019; 76:257-262. [PMID: 31012256 DOI: 10.1111/1747-0080.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
AIM The Ministry of Health in Malawi has scaled-up antiretroviral therapy (ART) for HIV infection. However, the majority of Malawians heavily depend on maize-based stiff porridge (nsima), a protein-deficient staple, a practice that exacerbates wasting and ultimately compromises the success of ART programming. This pilot study was conducted to evaluate the efficacy of utilising soybean-enriched nsima as a strategy for managing HIV-related wasting among resource-poor people. METHODS A before and after designed study involving 25 wasted (<18.5 BMI (body mass index)) to normal (18.5-24.9 BMI) HIV-positive rural women (21-40 years) taking ART and provided with soybean-maize flour (20 kg/month for 3 months) prepared from hydrothermally treated soybeans and maize in the ratio of 1:4 (wt/wt). Anthropometry was performed at baseline and every month for the 3-month study period. Paired sample t-tests were used to test for changes in body mass and BMI between baseline and the subsequent months. RESULTS Statistically significant (P < 0.001) cumulative mean weight gain for the first, second and third month of the study were 1.6, 2.1 and 2.9 kg, respectively. The number of participants with low BMI reduced from 6/25 at baseline to 2/25 after 3 months, and the mean BMI improved from 19.3 to 21.1 kg/m2 . CONCLUSIONS Nsima prepared from a blend of maize and hydrothermally treated soybeans could feasibly be used to prevent and manage wasting among resource-poor people living with HIV/AIDS in sub-Saharan Africa who rely on maize as a major staple.
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Affiliation(s)
- Karen Bhima
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Beatrice Mtimuni
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Limbikani Matumba
- Food Technology and Nutrition Group, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
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A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria. Public Health Nutr 2019; 22:2290-2302. [PMID: 31084656 DOI: 10.1017/s1368980019000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS ALH. RESULTS The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.
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Torgersen J, So-Armah K, Freiberg MS, Goetz MB, Budoff MJ, Lim JK, Taddei T, Butt AA, Rodriguez-Barradas MC, Justice AC, Kostman JR, Lo Re V. Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people. BMC Gastroenterol 2019; 19:52. [PMID: 30987601 PMCID: PMC6466708 DOI: 10.1186/s12876-019-0969-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
Background Hepatic steatosis is prevalent in Western countries, but few studies have evaluated whether the frequency and severity of steatosis are greater in the setting of HIV infection. We compared the prevalence and severity of hepatic steatosis between HIV-infected (HIV+) and uninfected persons and identified factors associated with greater steatosis severity within both groups. Methods We performed a cross-sectional study among participants without cardiovascular disease who participated in a substudy of the Veterans Aging Cohort Study. Hepatic steatosis was defined by noncontrast computed tomography (CT) liver-to-spleen (L/S) attenuation ratio < 1.0. Multivariable linear regression was used to: 1) evaluate the association between HIV infection and severity of hepatic steatosis, as measured by absolute liver attenuation, and 2) identify factors associated with greater severity of steatosis, by HIV status. Results Among 268 participants (median age, 55 years; 99% male; 79% black; 23% obese; 64% HIV+ [91% on antiretroviral therapy]), the overall prevalence of steatosis was 7.8% and was similar between HIV+ and uninfected individuals (13 [7.6%] versus 8 [8.2%], respectively; p = 0.85). Participants with HIV, the majority of whom received antiretroviral therapy, had a higher mean absolute liver attenuation (mean difference, 5.68 Hounsfield units; p < 0.001), correlating with lesser hepatic steatosis severity, compared to uninfected participants. After adjusting for covariates, only advanced hepatic fibrosis was associated with greater severity of steatosis in HIV+ persons (p = 0.03) and uninfected individuals (p < 0.001). Conclusions In this sample of participants without cardiovascular disease, the prevalence of hepatic steatosis by noncontrast abdominal CT was not different by HIV status. Increasing severity of steatosis was independently associated with advanced hepatic fibrosis in both groups. Electronic supplementary material The online version of this article (10.1186/s12876-019-0969-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessie Torgersen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3910 Powelton Ave 4nd Floor, Ste. 411F, Philadelphia, PA, 19104, USA.
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Matthew B Goetz
- Department of Medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph K Lim
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tamar Taddei
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA, and VA Connecticut Healthcare, West Haven, CT, USA
| | - Adeel A Butt
- Department of Medicine, Weill Cornell Medical College, Ar-Rayyan, Qatar
| | | | - Amy C Justice
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA, and VA Connecticut Healthcare, West Haven, CT, USA
| | - Jay R Kostman
- John Bell Health Center, Philadelphia FIGHT, Philadelphia, PA, USA
| | - Vincent Lo Re
- Department of Medicine and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Negessie A, Jara D, Taddele M, Burrowes S. Determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a case-control study design. BMC Nutr 2019; 5:20. [PMID: 32153933 PMCID: PMC7050723 DOI: 10.1186/s40795-019-0284-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background A complex and negatively reinforcing relationship exists between infection with Human Immune Deficiency Virus (HIV) and malnutrition. HIV-induced immune impairment and its resulting opportunistic infections (OIs) can lead to malnutrition and nutritional deficits, can, in turn, hasten the progression of HIV infection and reduce chances of survival. The determinants of undernutrition among patients receiving antiretroviral therapy (ART) is poorly understood in Ethiopia, despite a high prevalence of food-insecurity that overlaps with a generalized HIV/AIDS epidemic. Therefore, this study aimed to assess determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos Referral Hospital in Northwest Ethiopia. Methods We conducted an institution-based, unmatched, case-control study with 636 adult patients receiving antiretroviral therapy. We randomly selected 212 patients with poor nutritional outcomes (cases) and 424 without undernutrition (controls) and then conducted a chart review to collect information on their treatment, socio-economic, and demographic background. Data were analyzed using bivariable and multivariable logistic regression to identify factors associated with under nutrition. Results We found that greater age (AOR = 1.02, 95% CI: 1.01,1.05), fair or poor adherence (AOR = 2.77, 95% CI: 1.40, 5.50 and AOR = 4.72, 95% CI: 1.92, 11.6), and the presence of OIs (AOR = 1.70, 95% CI: 1.12, 2.52), anemia (AOR = 1.81, 95% CI: 1.07, 3.07), or eating problems (AOR = 3.40, 95% CI: 2.27, 5.10), were all independently and positively associated with under nutrition. Starting treatment with a medium or low CD4 count was protective (AOR = 0.61, 95% CI: 0.39, 0.96 and AOR = 0.49, 95% CI: 0.27, 0.88). Having social support (AOR = 0.64, 95% CI: 0.43, 0.95), and having a source of informal care-giving (AOR = 0.48, 95% CI: 0.27, 0.84), reduced the odds of undernutrition. Conclusion Our findings support calls for treating HIV infection early and aggressively, while closely monitoring patients for opportunistic infections that might affect eating and drug side effects that may affect appetite. The role of disclosure, peer-caregivers and age in preventing undernutrition should be explored in future research.
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Affiliation(s)
- Ayenew Negessie
- 1Department of Nutrition and Food Sciences, College of Medicine and Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Dube Jara
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Mekaunint Taddele
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Sahai Burrowes
- 3Public Health Program, College of Education and Health Sciences, Touro University California, 1310 Club Drive, Mare Island, Vallejo, CA 94592 USA
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Abstract
Nutritional counseling has been shown to improve dietary intake in individuals with human immunodeficiency virus (HIV)/AIDS. Registered dietitians/nutritionists can individualize diet interventions to optimize effectiveness in treating metabolic consequences of the HIV infection or highly active antiretroviral therapy. Nutrition management for individuals infected with HIV can be helpful in maintaining lean body weight, combating oxidative stress, reducing complications from hyperglycemia and hyperlipidemia, and managing gastrointestinal function. Consideration should be given to including the expertise of a registered dietitian/nutritionist.
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Affiliation(s)
- William Andrew Clark
- Department of Allied Health Sciences, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, PO Box 70282, Johnson City, TN 37614, USA.
| | - Eileen M Cress
- James H. Quillen Veterans Administration Medical Center, PO Box 4000, Mountain Home, TN 37684, USA
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Laar AK, Lartey MY, Ankomah A, Okyerefo MPK, Ampah EA, Letsa DP, Nortey PA, Kwara A. Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:26. [PMID: 30509309 PMCID: PMC6278010 DOI: 10.1186/s41043-018-0157-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health. OBJECTIVES We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV. METHODS Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0. RESULTS The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12-0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30-0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02-0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12-0.85). CONCLUSIONS The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming.
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Affiliation(s)
- Amos K. Laar
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Margaret Y. Lartey
- Department of Medicine, University of Ghana School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Augustine Ankomah
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Ernest A. Ampah
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Demi P. Letsa
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Priscillia A. Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI USA
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Lai SW, Lin CL, Liao KF. Weight loss might be an early clinical feature of undiagnosed human immunodeficiency virus infection in Taiwan. Biomedicine (Taipei) 2018; 8:19. [PMID: 30141406 PMCID: PMC6108225 DOI: 10.1051/bmdcn/2018080319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Little research is available on the relationship between weight loss and human immunodeficiency virus (HIV) infection in Taiwan. We hope to evaluate whether weight loss could be an early clinical feature of undiagnosed HIV infection in Taiwan. METHODS We conducted a retrospective population-based cohort study using the database of the Taiwan National Health Insurance (NHI) Program. There were 4748 male subjects aged 1-84 with newly diagnosed weight loss as the weight loss group from 1998-2012 and 18982 age-matched male subjects without weight loss as the non-weight loss group. The incidence of HIV infection at the end of 2013 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for HIV risk associated with weight loss. RESULTS The overall incidence of HIV infection was 3.79-fold higher in the weight loss group than in the non-weight loss group (6.83 vs. 1.80 per 10000 person-years, 95% CI 3.41, 4.21). The incidence was the highest during the first 6 months of follow-up in the weight loss group (39.0 per 10000 person-years). After adjusting for confounding factors, the adjusted HR of HIV infection was 3.63 (95% CI 1.77, 7.44) for the weight loss group, compared with the non-weight loss group. CONCLUSION Weight loss might be an early clinical feature of undiagnosed HIV infection in Taiwan. Male patients with weight loss who have risk factors for HIV infection should be recommended to regularly be tested for HIV infection.
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Affiliation(s)
- Shih-Wei Lai
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College of Medicine, China Medical University Taichung
404 Taiwan
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Department of Family Medicine, China Medical University Hospital Taichung
404 Taiwan
| | - Cheng-Li Lin
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College of Medicine, China Medical University Taichung
404 Taiwan
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Management Office for Health Data, China Medical University Hospital Taichung
404 Taiwan
| | - Kuan-Fu Liao
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College of Medicine, Tzu Chi University Hualien
970 Taiwan
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Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital Taichung
427 Taiwan
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Sidibé S, Delamou A, Kaba ML, Magassouba AS, Samake AT, Dongo YSA, Kadio KJJO, Dimio SS, Camara LM, Babalola S. The effects of nutritional supplementation on body mass index and CD4 count among adult people living with HIV AIDS on antiretroviral treatment in Conakry, Guinea. J Public Health Afr 2018; 9:708. [PMID: 30079161 PMCID: PMC6057713 DOI: 10.4081/jphia.2018.708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/15/2017] [Indexed: 11/23/2022] Open
Abstract
Whereas the HIV prevalence in Guinea is among the lowest in Africa, many PLHIV in Guinea are malnourished. This study assessed the effect of a nutritional supplementation program on body mass index and CD4 count among adult PLHIV on ART. Study participants were PLHIV who came for consultation in the study sites between May and July 2016. The data came from two sources: retrospectively from participants' medical records and interviews at the time of recruitment into the study. About six months before they were recruited into the study, some of the PLHIV started to receive a monthly nutritional supplementation consisting of Corn-Soy Blend and oil. Analytic methods included bivariate and multivariable methods. The intervention increased the mean BMI by 7.4% and the average current CD4 count by 4.7% compared to nonintervention (P<0.001). Programs in low resource settings should consider nutrition assistance as part of a comprehensive strategy to ensure optimal metabolic and immunological functions among PLHIV.
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Affiliation(s)
- Sidikiba Sidibé
- National Center for Training and Rural Health Research, Maferinyah, Guinea.,Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Alexandre Delamou
- National Center for Training and Rural Health Research, Maferinyah, Guinea.,Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Mohamed Lamine Kaba
- Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Aboubacar Sidiki Magassouba
- National Center for Training and Rural Health Research, Maferinyah, Guinea.,Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Amara Tabaouo Samake
- National Center for Training and Rural Health Research, Maferinyah, Guinea.,Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Yao Serge Arthur Dongo
- Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | | | - Sandouno Sah Dimio
- Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Lansana Mady Camara
- Faculty of Medicine, Pharmacy and Odonto-Stomatology, Gamal Abdel Nasser University, Conakry, Guinea
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, Johns Hopkins University, Baltimore, MD, USA
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Weldegebreal F, Digaffe T, Mesfin F, Mitiku H. Dietary diversity and associated factors among HIV positive adults attending antiretroviral therapy clinics at Hiwot Fana and Dilchora Hospitals, eastern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:63-72. [PMID: 29861644 PMCID: PMC5968811 DOI: 10.2147/hiv.s138638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Nutritional care is considered a crucial component of comprehensive care for people living with HIV/AIDS (PLWHA), particularly in resource-limited settings where malnutrition and food insecurity are endemic problems, and low quality monotonous diets are the norm. The findings of this study provide baseline information on dietary diversity and related factors for health care providers so that they will be able to improve nutritional care and support activity. Therefore, the aim of this study was to assess dietary diversity and associated factors among HIV positive adults (18-65 years old) attending antiretroviral therapy (ART) clinics at Hiwot Fana and Dilchora Hospitals, eastern Ethiopia. Patients and methods An institution-based cross-sectional study was conducted from November 2015 to February 2016 at the ART clinics of Hiwot Fana and Dilchora Hospitals. Using a systematic random sampling technique, a total of 303 patients were selected from all adults attending the ART clinics. The data were collected with a 95% CI used to show association between dietary diversity and independent factors. Results A total of 303 adult HIV positive individuals on ART participated in the study and 62.4% were females. The largest numbers of participants (49.5%) were 30-40 years of age. Eighty-seven (28.7%) participants had low dietary diversity (≤4 food groups). Duration of anti-retroviral treatment was the factor significantly associated with dietary diversity: respondents with a duration of antiretroviral treatment of more than 2 years were almost two times more likely to have high dietary diversity compared with those with less than a year of antiretroviral treatment (adjusted odds ratio =0.490; 95% CI: 0.091, 0.978). Conclusion Low dietary diversity was found to be a nutritional problem among HIV positive adults. Duration of antiretroviral treatment was the predictor of low dietary diversity. Therefore, appropriate dietary management of side effects of ART is important.
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Affiliation(s)
- Fitsum Weldegebreal
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Digaffe
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Frehiwot Mesfin
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Mitiku
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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