Nutritional status of HIV-infected patients during the first year HAART in two West African cohorts

Influence of HIV/AIDS Infection on Immunological and Nutritional Status in Adults and Older Adults: A Cross-Sectional Study in Kingdom of Bahrain

Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain, was carried out. Various biochemical markers were collected from patients' medical records, including CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine. A semi-structured questionnaire using a standardized food frequency questionnaire (FFQ) was used, from which total energy and total macronutrients were calculated. Results: The mean BMI of the participants was 27.20 kg/m2, and none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients' dietary intake of macronutrients and total calorie intake were either within or above the recommended RDA levels. The results also showed that all of the mean values of the nutritional and biochemical markers (CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine) were within the normal reference ranges. A significant positive correlation between CD4+ T cell count, Hb, HCT, and albumin at the <0.05 level was found. There was no significant correlation between CD4+ T cell count and MCV, WBCs, and creatinine. A positive significant correlation was found between BMI, CD4+ T cell count, and WBCs at the <0.01 level. Conclusion: The BMI values were significantly correlated with the biochemical markers of AIDS progression. The dietary patterns of the participants were undiversified, with a high prevalence of obesity and overweight. Malnutrition among this study population was not present.

Prediction of the risk of cytopenia in hospitalized HIV/AIDS patients using machine learning methods based on electronic medical records

Background

Cytopenia is a frequent complication among HIV-infected patients who require hospitalization. It can have a negative impact on the treatment outcomes for these patients. However, by leveraging machine learning techniques and electronic medical records, a predictive model can be developed to evaluate the risk of cytopenia during hospitalization in HIV patients. Such a model is crucial for designing a more individualized and evidence-based treatment strategy for HIV patients.

Method

The present study was conducted on HIV patients who were admitted to Guangxi Chest Hospital between June 2016 and October 2021. We extracted a total of 66 clinical features from the electronic medical records and employed them to train five machine learning prediction models (artificial neural network [ANN], adaptive boosting [AdaBoost], k-nearest neighbour [KNN] and support vector machine [SVM], decision tree [DT]). The models were tested using 20% of the data. The performance of the models was evaluated using indicators such as the area under the receiver operating characteristic curve (AUC). The best predictive models were interpreted using the shapley additive explanation (SHAP).

Result

The ANN models have better predictive power. According to the SHAP interpretation of the ANN model, hypoproteinemia and cancer were the most important predictive features of cytopenia in HIV hospitalized patients. Meanwhile, the lower hemoglobin-to-RDW ratio (HGB/RDW), low-density lipoprotein cholesterol (LDL-C) levels, CD4+ T cell counts, and creatinine clearance (Ccr) levels increase the risk of cytopenia in HIV hospitalized patients.

Conclusion

The present study constructed a risk prediction model for cytopenia in HIV patients during hospitalization with machine learning and electronic medical record information. The prediction model is important for the rational management of HIV hospitalized patients and the personalized treatment plan setting.

Snacking pattern of college students in Saudi Arabia: a cross-sectional study

BACKGROUND

Although unhealthy snack foods are commonly consumed by college students, snacking patterns among college students have not been comprehensively examined in Saudi Arabia. In our study, we aimed to investigate snacking patterns among Saudi college students and to assess sociodemographic data that affect adherence to these snacking patterns.

METHODS

Between January 2021 and March 2021 in Jeddah, Saudi Arabia, an online survey was conducted with 662 college students from a Saudi university. The survey included sociodemographic questions and a short food frequency questionnaire (FFQ) regarding the consumption of common snack foods. Snacking patterns were generated from the FFQ using the factor analysis method.

RESULTS

Factor analyses generated seven snacking patterns, which explained 64.5% of the variance in snacking. Students in their early academic years (1-3 years) had a higher score for the convenience snack and fast-food pattern (0.22 ± 0.48 and 0.31 ± 0.52, respectively) than senior students (4-6 years) (P = 0.03 and 0.04, respectively). Healthy snacks patterns were higher among students at higher income levels (P = 0.006) and active students (P < 0.001) than among students at low- or mid-income levels and inactive students. Higher adherence to the beverages pattern was observed among male students (P = 0.03), active students (P = 0.01), and students with obesity than their counterparts (P = 0.02). The dairy products pattern was higher among male students (P = 0.04), students at higher income levels (P = 0.04), and students with obesity (P = 0.03) than their counterparts.

CONCLUSIONS

Most snacking patterns identified among the study participants were considered unhealthy. Adherence to healthy snacks is influenced by physical activity and family income. These findings may be helpful in the future for developing adequate nutrition education programs that promote health by adhering to healthy snack choices in this critical age group. Further studies are needed to confirm these findings and to investigate snacking patterns among other age groups in Saudi Arabia.

The Nutritional Status of Adult Antiretroviral Therapy Recipients with a Recent HIV Diagnosis; A Cross-Sectional Study in Primary Health Facilities in Gauteng, South Africa

The study determined the nutritional status of adult antiretroviral therapy (ART) recipients, and investigated the association between the duration on ART and the nutritional status. This study was based in primary health facilities in Gauteng, South Africa. The data collected included sociodemographic variables; the duration of the treatment; and the body mass index (BMI), classified as undernutrition (<18.5 kg/m²), normal (18.5–24.9 kg/m²), or overweight/obesity (≥25 kg/m²). ART recipients (n = 480) had a mean age of 35 (± 8.4SD) years. All had taken ART for six months or more (range 6–48 months). The data were analyzed using STATA 13.0. The overall prevalence of overweight/obesity was 39%, it was higher in females (46%) than in males (30%), 26% were overweight, and 13% were obese. Underweight was 13%, and was higher in males (18%) than females (9%). Being overweight was more likely in those aged ≥35 years and those in smaller households. Being obese was less likely in males, in the employed, and in those with a higher income, but was more likely in those with a longer duration on ART. Abdominal obesity was high, but less likely in males. Interventions to prevent overweight/obesity should be integrated into routine HIV care, while at the same time addressing the burden of undernutrition among ART recipients.

Factors associated with insufficient weight gain among Mexican pregnant women with HIV infection receiving antiretroviral therapy

Objective

We identified clinical, dietary, and socioeconomic factors associated with insufficient gestational weight gain among Mexican pregnant women with human immunodeficiency virus (HIV) infection.

Methods

This was a cross-sectional study involving 112 pregnant women with HIV infection receiving antiretroviral therapy (ART). Data including viral load, complete blood analysis, and CD4 counts were extracted from medical records. An inquiry form was used to collect data on socioeconomic status and frequency of food intake. Pre-gestational weight was calculated based on pregnancy weight to obtain the body mass index (BMI) and weight gain for gestational age according the US Institute of Medicine. Of the study population, 68.7% were in consensual union, 31.3% were single, and 33.9% belonged to the two lowest socioeconomic strata. The median age and CD4 count were 27 (interquartile range [IQR]: 23–32) years and 418 (IQR: 267–591), respectively. The adequacy of energy was 91.8% (IQR: 74.1–117.7). The median energy intake from protein was 13.5% (IQR: 12.2–14.9) and from lipids, 35.5% (IQR: 31.1–40.3). Pregnant women with gastrointestinal symptoms and CD4 count <350 were seven times more likely to have folate deficiency (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.6–38.1; p = 0.009) and six times more likely to have poor zinc intake (OR 6.7, 95% CI 1.3–36.8; p = 0.014). In all, 42.9% of the pregnant women consumed iron and folic acid supplements and 54.4% consumed multivitamin supplements. Moreover, 45.5% had a normal pre-gestational BMI, 41.1% were classified overweight, and 13.4% had obesity, whereas 62.5% showed insufficient gestational weight gain, and 18.8% experienced weight loss. The variables associated with insufficient weight gain were consensual union (OR 5.3, 95% CI 1.9–15.0; p = 0.002) and belonging to the lowest socioeconomic stratum (E) (OR 3.1, 95% CI 1.0–9.2; p = 0.046).

Conclusion

Dietary strategies to improve gestational weight gain for Mexican women with HIV infection receiving ART must consider clinical and socioeconomic factors.

Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study

INTRODUCTION

Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia.

METHODS AND SETTING

The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach.

RESULTS

Amongst study participants, 55.3% (95% CI = 53.2‒57.4) recovered from malnutrition, 19% (95% CI, 17.3‒20.7) did not complete the program, and 21% (95% CI = 19.7‒23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05‒1.97), employed (AOR = 1.39, 95% CI = 1.01‒1.93), attending Shul (AOR = 4.6, 95% CI = 3.15‒6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69‒3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59‒3.91) and III (AOR = 1.46(1.02‒2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09‒2.39), anaemic (AOR = 1.77, 95% = 1.29‒2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69‒8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4‒2.91), attending Shul (AOR = 2.92, 95% CI = 2.04‒4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05‒2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15‒0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28‒0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02‒5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation.

CONCLUSION

There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV.

Anemia and its associated factors among adult people living with human immunodeficiency virus at Wolaita Sodo University teaching referral hospital

BACKGROUND

In Sub-Saharan Africa, both HIV/AIDS and anemia have considerable public health problems. Anemia has an adverse effect on treatment outcome and it decreases the quality of life among adult HIV patients. This study was aimed to assess the prevalence of anemia and its associated factors among adult HIV positive patients in Wolaita Sodo University Teaching Referral Hospital.

METHOD

Institution based cross-sectional study was conducted at Wolaita Sodo University Teaching Referral Hospital from 01 October to December 30, 2016. A randomly selected 411 adult people living with the human immunodeficiency virus were included in the study. A pre-tested questionnaire was used to collect data. Variables with P-value ≤0.25 in the bivariable logistic regression model were taken into multivariable logistic regression analysis along with 95% confidence interval and Odds Ratio was used to examine the association between anemia and independent variables. P-value ≤ 0.05 was taken as statistically significant.

RESULT

Prevalence of anemia in this study was 36.5% with 95% CI (32%-41%). Factors associated with anemia among adult people living with HIV/AIDS were individuals who lived with HIV ≥9years (AOR = 2.6, 95% CI:-1.03-6.59),years lived with HIV 5-8 years (AOR = 2.59, 95% CI:-1.02-6.57),CD4 count <200cells/ul (AOR = 4.2, 95%CI:-2.03-8.67), CD4 count200-350cells/ul(AOR = 1.82,95%CI:-1.01-3.26),infection with intestinal parasites (AOR = 2.04, 95% CI:-1.06-3.95), Participants with BMI <18.5kg/m2 (AOR = 2.96, 95%CI:-1.37-6.390),BMI 18.5-25kg/m2(AOR = 1.98, 95%CI:-1.11-3.56) and being HAART naïve (AOR = 2.23, 95% CI:- 1.16-4.28).

CONCLUSION

Prevalence of anemia among this study participant was high. This may affect the treatment outcome, increases morbidity and mortality of the participants. So periodic screening of anemia, a routine checkup of nutritional status, CD4 count and examination for intestinal parasite are essential.

Serum albumin and mortality in patients with HIV and end-stage renal failure on peritoneal dialysis

Background

Peritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes.

Methods

We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy.

Results

The HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02–6.46, p<0.001) at baseline and 3.99 g/L (95% CI 1.19–6.79, p = 0.006) at 18 months. HIV-positive status (adjusted regression coefficient -2.84, CI -5.00–-0.67, p = 0.011), diabetes (adjusted coefficient -2.85; CI, -5.58–-0.12; p = 0.041), and serum C-reactive protein and blood hemoglobin levels were independent predictors of serum albumin levels on multivariable linear regression. Baseline serum albumin <25 g/L (subdistribution-hazard ratio [SHR] 13.06, 95% CI 3.09–55.14, p<0.001) and CD4⁺ cell count <200 cells/μL (SHR 3.2, CI 1.38–7.45, p = 0.007) were independent predictors of mortality in our competing risk model.

Conclusions

HIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.

HIV and the dual burden of malnutrition in Senegal, 1994-2012

The aims of this study were to determine the nutritional status of HIV-positive versus HIV-negative adults in Senegal and to identify predictors of nutritional status among people living with HIV (PLHIV). We conducted a retrospective study using data from individuals enrolled in previous studies in Senegal. Undernutrition was defined as body mass index (BMI) <18.5 and overnutrition was defined as BMI ≥25.0. Subcategories of overnutrition were overweight (defined as BMI 25.0-29.9) and obesity (BMI ≥30.0). Predictors of nutritional status were identified using multinomial logistic regression. Data from 2448 adults were included; 1471 (60%) were HIV positive. Among HIV-negative individuals, the prevalence of undernutrition decreased from 23% in 1994-1999 to 5% in 2006-2012, while the prevalence of overnutrition increased from 19 to 55%. Among PLHIV, undernutrition decreased from 52 to 37% and overnutrition increased from 10 to 15%. Women had greater odds of obesity (odds ratio [OR] 11.4; p < 0.01). Among HIV-positive women, undernutrition was associated with WHO stage 3 or 4 and CD4 cell count <200; antiretroviral therapy (ART) and education were protective. Obesity was associated with age > 35 years, commercial sex work, and alcohol use. Among HIV-positive men, WHO stage 3 or 4 and CD4 cell count <200 were predictive of undernutrition; ART was protective. Our study highlights the need for the integration of nutrition interventions into HIV programs in Senegal and suggests that for nutrition programs to be most effective, strategies may need to differ when targeting men versus women. Furthermore, improving access to education and focusing on women for nutrition interventions could be of particularly high impact at the household level.