Chronic energy deficiency and associated factors among adults living with HIV in Gondar University Referral Hospital northwest Ethiopia

Abstract

Background: Human Immunodeficiency Virus (HIV) infection and chronic energy deficiency are bidirectional and multifaceted. HIV can cause or worsen chronic energy deficiency by increasing energy requirements, reducing food intake and nutrient absorption. Chronic energy deficiency weakens the immune system, increase the susceptibility to infections and worsening the disease impact. Studies on the magnitude and factors associated with chronic energy deficiency among adults living with HIV are limited. The aim of this study was to assess the prevalence of chronic energy deficiency and associated factors among adults living with HIV in Gondar University Referral Hospital, northwest Ethiopia. Methods: An institution based cross-sectional study was conducted and systematic random sampling was used to select study subjects. A total of 317 study subjects were enrolled in the study. Structured and pretested questionnaire was used to collect socio-demographic, economic and diet related variables. Weight and height measurement were taken and medical charts were reviewed. Laboratory analysis for CD4 count and anemia was done. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy deficiency. Results: A total of 317 patients provide complete information with response rate of 99.4%. The overall prevalence of chronic energy deficiency was 18.3% (95%CI: 14.5%-22.7%). The prevalence of mild, moderate and severe chronic energy deficiency was 11.4, 3.5 and 3.5% respectively. No formal education (AOR = 2.05,95%CI:1.01,4.21), being in the WHO clinical stage three and four (AOR = 3.84,95%CI:1.39,10.61) and history of diarrhea in the last two weeks prior to the survey (AOR = 4.43,95%CI:1.83,10.72) were significantly associated with chronic energy deficiency. Conclusion: The prevalence of chronic energy deficiency among adults living with HIV was medium public health problem. Educational status, WHO clinical stage, and history of diarrhea in the last two weeks prior to the survey were risks for chronic energy deficiency. Integration of nutritional management with HAART, early diagnosis and treatment of diarrheal disease would be supreme important.

<p>Undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in the Arba Minch area, southern Ethiopia</p>

“…A cohort study in Singapore showed that there was a significant association between clinical disease stage and nutritional status 40. Similarly, the studies at Gonder and West Shewa Zone Ethiopia and Kathmandu Valley, Nepal indicated that the risk of undernutrition increased from WHO clinical stage 1 to 4 23,29,31. There was a relationship between weight change and HIV clinical stage, which showed that there were distinct patterns of weight loss that occured in stage 4 HIV infection 41…”

Undernutrition among Ethiopian adults living with HIV: a meta-analysis

“…In the present meta-analysis, four Ethiopian regions and one administrative town were represented. Five of the studies were from Amhara [4,[26][27][28][29], three from Oromia [24,30,31], five from Southern Region [25,[32][33][34][35], one from Tigray [36], and one from Addis Ababa [37]. However, no studies were located in Benishangul Gumiz, Harari, or Gagmbela regions.…”

“…Regarding statistical quality and data presentation, the majority of studies had poor statistical quality and data presentation methods. Besides, to identify factors associated with malnutrition, the majority [4,[24][25][26][27][28][29][30][31][32][33][34][35][36] of studies used binary logistic regression model for analysis, but one of the studies used Pearson correlation coefficients to determine the associations association between nutritional and immunological status [37]. Concerning the model fitness test, only two studies reported about model fitness using Hosmer and Lemeshow goodness of fit test [29,33].…”

Undernutrition and associated factors among adult HIV/AIDS patients receiving antiretroviral therapy in eastern zone of Tigray, Northern Ethiopia: a cross-sectional study

“…Undernutrition is the predominant problem for HIV infected patients. It creates a vicious cycle which may catalyze progression from HIV infection to AIDS [3]. Poor nutrition resulting in weight loss, muscle wasting, weakness, nutrient deficiencies then it leads impaired immune system (poor ability to fight HIV and other infections, increased oxidative stress, increased vulnerability to infections).…”

“…The effect of malnutrition by itself can reduce the cluster of differentiation-four (CD4+) T cells and lead to abnormal B-cell response. For HIV infected patients, poor nutrition aggravates the effect of HIV by further decreasing the immune system [3,5], thereby leading in undernutrition, increasing the risk of morbidity and mortality, and potentially reducing the efficacy of antiretroviral therapy (ART) [6].…”