Correlation between the immuno-virological response and the nutritional profile of treatment-experienced HIV-infected patients in the East region of Cameroon

Abstract

Background HIV management remains concerning and even more challenging in the frame of comorbidities like malnutrition that favors disease progression and mortality in resource-limited settings (RLS). Objective To describe the nutritional parameters of antiretroviral therapy (ART) recipients (without nutritional support) with respect to CD4 count and virological failure. Methods A cross-sectional study was conducted from October to December 2018 among 146 consenting participants enrolled in two health facilities of the East-Region of Cameroon. Socio-demographic data, basic clinical information and treatment history were collected; blood samples were collected by venipuncture for laboratory analysis (HIV-1 viral load, CD4 Tcells measurement and biochemical analysis) performed at the “Chantal Biya” International Reference Center”, Yaounde, Cameroon. The nutritional profile was assessed by using anthropometric and biochemical parameters. Data were analyzed using Excel 2016, Graph pad prism version 6; Spearman correlation and Kruskal-Wallis test were used; with p<0.05 considered statistically significant. Results Median [IQR] age was 42 [33–51] years, 76.0% (111/146) were female and median [IQR] duration on ART was 54 [28–86] months. Of these participants, 11.6% (17/146) were underweight based on the body mass index and 4.7% (7/146) were at the stage of advanced weight loss. According to immunovirological responses, 44.5% (65/146) were immunocompromised (CD4<500 cell/μl) and 75.3% (110/146) had an undetectable viremia (<40 copies/mL). CD4 count inversely correlated with total protein concentration (r = -0.18, p = 0.005**). Viremia was inversely correlated with albumin (r = -0.21; p = 0.047*), nutritional risk index (r = -0.28; p = 0.013*), total cholesterol (r = -0.27; p = 0.007**), and positively correlated with total protein (r = 0.27; p<0.001**) concentrations. Conclusion In this RLS, with patients having about five years of ART-experience, malnutrition appears to be driven mainly by a poor BMI, indicating that about one of ten patients falls within this severe condition. However, the largely normal nutritional profiles should be interpreted with caution, considering local realities and food support programs in place. The present outcomes highlight the need for monitoring nutritional status of people receiving ART in RLS, toward the design of optimal food interventions.

Predictors and Facilitators of High Viral Load in HIV Positive Persons on Antiretroviral Treatment in the East Region of Cameroon

“…Living with family members exposes clients on ART who has not discloses their HIV status to their family members to stigma and discrimination which often lead to the patients' missing doses or even abandoning treatment. These findings were consistent with studies in Ethiopia and Cameroon [25,26].…”

Immuno-virological status and its associated factors among HIV-positive patients receiving highly active antiretroviral therapy at delgi primary hospital, northwest Ethiopia, 2020/2021: A cross-sectional study

“…However, the present prevalence was comparatively lower than the findings including a study done in Addis Ababa 15.7% [ 41 ] and 15% [ 42 ], and studies in the University of Gondar referral hospital 15.1 [ 43 ], 47.1% and 12.3% [ 33 , 44 ] respectively, Kenya 64.4% [ 45 ], Tanzania 25% [ 46 ], China 18.4% [ 47 ], Colombia 14% [ 48 ], Thailand 33.5% [ 49 ], Nepal 35% [ 50 ], a prospective observational cohort (n = 158) study in the developing Caribbean country 21.5% [ 51 ] and a study in England 47.6% [ 52 ]. The variation in the magnitude of immunological failure may be explained due to the difference in the socio-economic conditions, the definition of immunological failure, the duration of HAART [ 22 , 23 , 25 , 32 , 33 , 35 , 43 ], medication adherence [ 26 , 41 , 53 ], study design, sample size and setting [ 26 , 38 , 54 , 55 ], and immuno-virological discordance [ 15 , 17 , 18 , 21 , 38 , 56 ]. Also, the discrepancy can be explained by the emergence of drug-resistance among HIV-positive patients [ 10 , 16 , 37 , 40 ], their functional status [ 57 ], poor nutritional support [ 18 ], high burden of OIs [ 3 , 11 , 58 ], poor ART care, late initiation of HAART as well as ART-associated adverse reaction [ 23 ].…”

“…21.5% [51] and a study in England 47.6% [52]. The variation in the magnitude of immunological failure may be explained due to the difference in the socio-economic conditions, the definition of immunological failure, the duration of HAART [22,23,25,32,33,35,43], medication adherence [26,41,53], study design, sample size and setting [26,38,54,55], and immuno-virological discordance [15,17,18,21,38,56]. Also, the discrepancy can be explained by the emergence of drug-resistance among HIV-positive patients [10,16,37,40], their functional status [57], poor nutritional support [18], high burden of OIs [3,11,58], poor ART care, late initiation of HAART as well as ART-associated adverse reaction [23].…”

“…HIV-infected patients on HAART have shown a remarkable reduction in AIDS-related clinical impacts such as mortality, morbidity, and associated psychosocial problems. This is because the risk to develop AIDS-related mortality and the poorer therapeutic outcome are heavily dependent on the immune system, viral suppression, and the supportive nutritional status of the individuals [ 16 , 17 , 18 ].…”

Dietary pattern association with CD4 cells count in patients living with human immunodeficiency virus: A cross-sectional study

“…2 HIV can cause several health complications, including opportunistic infections, oxidative stress, wasting syndrome, and malnutrition. [3][4][5] Many metabolic changes occur in people living with HIV (PLWH). HIV damages the immune system by targeting CD4 cells.…”