Nutrition outcomes of HIV‐infected malnourished adults treated with ready‐to‐use therapeutic food in sub‐Saharan Africa: a longitudinal study

Abstract

BackgroundAmong people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure.MethodsWe present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m2 enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression.ResultsOverall, 1340 of 8685 (15.4%) HIV-positive adults were enrolled in the nutrition programme. At admission, median body mass index was 15.8 kg/m2 (IQR 14.9-16.4) and 12% received combination antiretroviral therapy (ART). After a median of four months of follow up (IQR 2.2-6.1), 524 of 1106 (47.4%) patients were considered cured. An overall total of 531 of 1106 (48.0%) patients failed nutrition therapy, 132 (11.9%) of whom died and 250 (22.6%) defaulted from care. Men (OR = 1.5, 95% CI 1.2-2.0), patients with severe malnutrition at nutrition programme enrolment (OR = 2.2, 95% CI 1.7-2.8), and those never started on ART (OR = 4.5, 95% CI 2.7-7.7 for those eligible; OR = 1.6, 95% CI 1.0-2.5 for those ineligible for ART at enrolment) were at increased risk of nutrition programme failure. Diagnosed tuberculosis at nutrition programme admission or during follow up, and presence of diarrhoeal disease or extensive candidiasis at admission, were unrelated to nutrition programme failure.ConclusionsConcomitant administration of ART and ready-to-use therapeutic food increases the chances of nutritional recovery in these high-risk patients. While adequate nutrition is necessary to treat malnourished HIV patients, development of improved strategies for the management of severely malnourished patients with HIV/AIDS are urgently needed.

Preferences for food and nutritional supplements among adult people living with HIV in Malawi

“…Perceptions and experiences of PLHIV and HSA living in different regions of Malawi may differ. However, the study findings are consistent across different sources of information (PLHIV and HSA), sex (male and female) and are consistent with findings of studies from other African countries (14,17,18) . Participants' responses to some topics, particularly the positive influence of eating behaviours attributed to counselling sessions imparted by HSA, and food habits, might have been biased, due to a social desirability, especially because the IDI were conducted at the Chilomoni clinic.…”

“…RUTF shows promising results in achieving a more prompt restoration of BMI (14,27) and fatfree mass (27) , and is increasingly being used in nutrition supplementation programmes (18) . However, increasing evidence shows that the acceptance of RUTF is low among adult PLHIV (14,17) .…”

Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?

“…24e26 The importance of ready-to-use therapeutic food (RUTF) in malnourished HIV-infected patients has been established. 27 In a similar fashion, malnourished TB patients are likely to benefit from RUTF. However, further studies are required to confirm the role of RUFT in malnourished TB patients.…”

Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals

“…Ready-to-use therapeutic foods effectively treat malnutrition of HIV-infected individuals in developing nations [18]. In a study of 1340 HIV-infected adults in sub Saharan Africa with body mass indices of less than 17 kg/m 2 , ready-to-use therapeutic food (2000 kilocalories per day) increased the chances of nutritional recovery in severely malnourished HIV-infected patients [18]. However, this retrospective analysis also showed that 48% of patients failed therapy because of lost-to-follow-up, poor adherence to ART, or severe malnutrition at baseline.…”