Body mass index variation over time and associated factors among HIV-positive adults on second-line ART in north-west Ethiopia: a retrospective follow-up study

Abstract

ObjectivesThis study aimed to assess the evolution of body mass index (BMI) of HIV-positive adults on second-line antiretroviral therapy (ART) over time and factors affecting it in north-west Ethiopia.DesignAn institution-based retrospective follow-up study was conducted using data extracted from 1016 patient cards from February 2008 to February 2016.SettingEight referral hospitals from Amhara region, Ethiopia were included.ParticipantsHIV patients who started second-line ART.Outcome measuresChange in BMI since starting second-line ART.ResultsFive hundred and thirty-eight (52.95%) participants were males and the median age of the participants was 33 years (IQR: 28; 39). The median follow-up time was 18 months (IQR: 5.2; 32.2). The average change of BMI showed linear increase over time. The amount of BMI increment or decrement according to each variable was shown as β coefficients. Treatment duration (β=0.013, 95% CI 0.004 to 0.022), isoniazid prophylaxis (β=0.87, 95% CI 0.32 to 1.42), cotrimoxazole prophylaxis (β=0.63, 95% CI 0.08 to 1.19), ambulatory functional status (β=−1.16, 95% CI −1.95 to 1.31), bedridden functional status (β=−1.83, 95% CI −2.47 to 1.21), WHO stage III (β=−0.42, 95% CI −0.65 to 0.20), WHO stage IV (β=−0.62, 95% CI −1.02 to 0.22), CD4 count (β=0.001, 95% CI 0.0008 to 0.0015), and time interaction of variables like tertiary educational status (β=0.02, 95% CI 0.01 to 0.04), ambulatory functional status (β=0.03, 95% CI 0.01 to 0.05) and WHO stages III (β=0.01, 95% CI 0.007 to 0.02) were found to be significant predictors.ConclusionThe BMI of patients has shown linear increment over the treatment time. Factors affecting it have been identified but its effect on cardiovascular disease needs further study.

Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis

“…However, the weight gain rate over time in participants with working functional status was less than participants with ambulatory or bedridden functional status. This finding is consistent with studies conducted elsewhere19 42 and likely reflects HIV disease severity before ART initiation and the return to health in patients with more advanced disease. Finally, there is a higher rate of weight gain among participants who did not take IPT compared with those who took IPT.…”

Effect of dolutegravir-based first-line antiretroviral therapy on weight and body mass index among adult people living with HIV on follow up at health facilities in Hawassa city administration, Southern Ethiopia: a retrospective cohort study

“…The finding of this study indicated that subjects with ambulatory and bedridden functional status had 2.0 times higher odds to gain ≥10% of their initial weight than those with working functional status. This finding is consistent with other studies conducted elsewhere [ 32–34 ]. In addition, the present study indicated that people with advanced WHO clinical stages (stages III and IV) during ART initiation had 1.78 times higher odds to gain ≥10% of their initial weight than those with mild clinical stages (stages I and II).…”

Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis

“…The average BMI level is increased by 0.2 kg/m 2 for a one-unit increase in the ART follow -up number of HIV-positive adults. This finding is consistent with prior related studies conducted in Ethiopia 32 – 35 , Tanzania 36 , South Africa 37 , 38 , and United States America 39 . The increase in BMI level over time in patients who are on ART could be due to the reduction in the metabolic demand of body cells 40 , the reversal of HIV-associated catabolism 41 , the return of gastrointestinal function, the decreased incidence of opportunistic infections 20 , 21 and the redistribution of fat as a component of Lipodystrophy 42 , 43 .…”

“…The BMI increment status of HIV-positive adults with advanced HIV stages is low compared to patients with WHO stages I or II clinical illnesses. The finding is supported by prior studies conducted in Ethiopia 25 , 32 , 34 , 54 , Zimbabwe 55 , Nepal 56 and USA 40 . The decline in BMI status might be due to the presence of high nutritional requirements or calorie expenditures and the poor appetite and absorption of nutrients in individuals with advanced-stage clinical disease 4 .…”