Rate, risk factors and estimations of time to develop severe acute malnutrition after children receiving antiretroviral therapy at selected health facilities in northwest Ethiopia

Abstract

Severe acute malnutrition (SAM) affects up to 50 % of children with HIV, especially those who reside in resource-constrained healthcare setting like Ethiopia. During subsequent follow-up of children factors related to incidence of SAM after antiretroviral therapy (ART) is set on, however, there is no prior evidence. An institution-based retrospective cohort study was employed among 721 HIV-positive children from 1 January to 30 December 2021. Data were entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. Bi-variable and multivariable Cox-proportional hazard models were employed at 95 % confidence intervals to identify significant predictors for SAM. According to this result, the overall mean (±sd) age of the participants was found to be 9⋅83 (±3⋅3) years. At the end of the follow-up period, 103 (14⋅29 %) children developed SAM with a median time of 30⋅3 (13⋅4) months after ART initiation. The overall incidence density of SAM was found to be 5⋅64 per 100 child (95 % CI 4⋅68, 6⋅94). Children with CD4 counts below the threshold [AHR 2⋅6 (95 % CI 1⋅2, 2⋅9, P = 0⋅01)], disclosed HIV status [AHR 1⋅9 (95 % CI 1⋅4, 3⋅39, P = 0⋅03)] and Hgb level ≤10 mg/dl [AHR 1⋅8 (95 % CI 1⋅2, 2⋅9, P = 0⋅03)] were significant predictors for SAM. Significant predictors of acute malnutrition were having a CD4 count below the threshold, children who had previously reported their HIV status, and having haemoglobin <10 mg/dl. To ensure better health outcomes, healthcare practitioners should improve earlier nutritional screening and consistent counselling at each session of care.

Proportion of active tuberculosis among HIV-infected children after antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

“…In contrast to previous systematic review findings [ 53 , 55 ] and primary studies reported [ 12 , 17 , 32 , 33 , 38 , 57 – 60 ] this meta-regression found no significant association between declined CD4 count (≤200 cells/cml), age of patients, duration of follow-up, comorbidity status, and functional status with the risk developing active TB in HIV co-infection children. This might be related to the methodological differences, heterogeneity of included study populations, sample size limitations, publication bias, unaccounted factors, and further experimental studies are highly needed to better understand this relationship.…”

“…Consistent with previous studies finding in [ 12 , 17 , 32 , 33 , 38 , 57 – 60 ],concurrent administering of IPT after ruled-out of active TB symptoms with ART demoted more than 90% of active TB-associated incidence of morbidity [ 3 , 61 , 62 ]. In the final report of this systematic review and meta-analysis, it was found that HIV-infected children who did not receive IPT (preventive therapy) were at a twofold higher risk compared to the control group.…”

“…By the end of 2022, only 46% of children (aged 0–14 years) who were receiving antiretroviral therapy (ART) were able to achieve viral load suppression, which is a crucial factor in reducing the occurrence of new opportunistic infections [ 5 , 8 , 11 ]. However, TB infection remains responsible for one in every third deaths of HIV infected children in source-limited setting [ 7 , 12 , 13 ]. Ethiopia is one of the top 30 countries burdened by tuberculosis (TB) and experiences a significant distribution of TB and HIV co-infection across all regions.…”

“…However, IPT completion rate and adherence of ART has affected by caregivers and regimen characteristic [ 18 ]. Although several small-scale studies have reported on the epidemiology of TB/HIV co-infection among HIV-infected children in various parts of Ethiopia [ 5 , 12 , 13 ]; however, there is a lack of aggregated data on co-infection after HIV-infected children started antiretroviral therapy. Therefore, this systematic review and meta-analysis aimed to estimate the pooled burden of active TB among HIV-infected children.…”

Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

“…HIV- infection and undernutrion coexists in a viscous cycle and deadly duo with each one fuelling the other [ 11 , 20 ]. Children living with HIV are more vulnerable to undernutrition [ 21 ] due to several mechanisms: HIV- infection exposed children for decreased appetite [ 22 ], increase energy needs as a result of infection, exacerbating of gastrointestinal infections, enteropathy and food insecurity [ 20 ]. Moreover, children with HIV are prone to undernutrion due to reduced food intake resulting from decreased appetite [ 23 ], poor absorption of nutrients that result of recurrent or chronic diarrhea [ 24 ], increased energy needs as a result of virus replication and opportunistic infections [ 25 ].…”