Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa

Koethe, John R.; Blevins, Meridith; Bosire, Claire; Nyirenda, Christopher; Kabagambe, Edmond K.; Mwango, Albert; Kasongo, Webster; Zulu, Isaac; Shepherd, Bryan E.; Heimburger, Douglas C.

doi:10.1017/s1368980012002960

Cited by 19 publications

(18 citation statements)

References 34 publications

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“…80 Increased hunger on ART has been hypothesized to be related to improved appetite after immunologic recovery and decreases in circulating cytokines. 86–88 …”

Section: Resultsmentioning

confidence: 99%

A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS

et al. 2013

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Adherence to antiretroviral therapy (ART) is critical for reducing HIV/AIDS morbidity and mortality. Food insecurity (FI) is emerging as an important barrier to adherence to care and treatment recommendations for people living with HIV (PLHIV), but this relationship has not been comprehensively examined. Therefore, we reviewed the literature to explore how FI may impact ART adherence, retention in medical care, and adherence to health care recommendations among PLHIV. We found data to support FI as a critical barrier to adherence to ART and to other health care recommendations among HIV-infected adults, HIV-infected pregnant women and their HIV-exposed infants, and child and adolescent populations of PLHIV. Associations between FI and ART non-adherence were seen in qualitative and quantitative studies. We identified a number of mechanisms to explain how food insecurity and ART non-adherence may be causally linked, including the exacerbation of hunger or ART side effects in the absence of adequate food and competing resource demands. Interventions that address FI may improve adherence to care and treatment recommendations for PLHIV.

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“…80 Increased hunger on ART has been hypothesized to be related to improved appetite after immunologic recovery and decreases in circulating cytokines. 86–88 …”

Section: Resultsmentioning

confidence: 99%

A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS

et al. 2013

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“…Community-based initiatives targeting at-risk malnourished patients, many of whom also have reduced functional status, appear to be needed in such settings. 43–45 As PEPFAR moves from the emergency to the consolidation phase, with an increasing proportion of scale-up activities occurring in rural settings, it becomes even more important to employ program data in assessing performance and determining what changes can be implemented that would make services more efficient, effective and sustainable by local host governments in such settings. 46 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Delayed Initiation of Combination Antiretroviral Therapy in Rural North Central Nigeria

Aliyu

Blevins

Parrish³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Timely initiation of combination antiretroviral therapy (ART) in eligible HIV-infected patients is associated with substantial reductions in mortality and morbidity. Nigeria has the second largest number of persons living with HIV/AIDS in the world. We examined patient characteristics, time to ART initiation, retention and mortality at five rural facilities in Kwara and Niger states of Nigeria. Methods We analyzed program-level cohort data for HIV-infected, ART-naïve clients (≥15 years) enrolled from June 2009-February 2011. We modeled the probability of ART initiation among clients meeting national ART eligibility criteria using logistic regression with splines. Results We enrolled 1,948 ART-naïve adults/adolescents into care, of whom 1174 were ART eligible (62% female). Only 74% of eligible patients (n=869) initiated ART within 90 days post-enrollment. The median CD4+ count for eligible clients was 156 cells/μL [IQR: 81–257], with 67% in WHO stage III/IV disease. Adjusting for CD4+ count, WHO stage, functional status, hemoglobin, body mass index, sex, age, education, marital status, employment, clinic of attendance, and month of enrollment, we found that immunosuppression (CD4 350 vs. 200, odds ratio (OR)=2.10 [95%CI: 1.31, 3.35], functional status (bedridden vs. working, OR=4.17 [95%CI: 1.63–10.67]), clinic of attendance (Kuta hospital vs. referent: OR=5.70 [95%CI:2.99–10.89]), and date of enrollment (December 2010 vs. June 2009: OR=2.13 [95%CI:1.19–3.81]) were associated with delayed ART initiation. Conclusion Delayed initiation of ART was associated with higher CD4+ counts, lower functional status, clinic of attendance, and later dates of enrollment among ART-eligible clients. Our findings provide targets for quality improvement efforts that may help reduce attrition and improve ART uptake in similar settings.

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“…Food insecurity may or may not be accompanied by hunger, which is defined as the "uneasy or painful sensation caused by a lack of food" [43]. In the HIV-infected, anorexia is very common [44]. In HIV-infected patients, there is also food insufficient.…”

Section: Food Insecurity and Undernutrition In Treated Hiv Patients Amentioning

confidence: 99%

Food insecurity and undernutrition in treated HIV patients a (post-) conflict setting: A cross sectional study from Goma, Eastern Democratic Republic of Congo

Akilimali¹

2016

JNHFS

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Objective: To assess the prevalence of food insecurity and its impact on nutritional status among HIV infected patients on antiretroviral therapy in a conflict and post conflict setting.Design: Cross-sectional study.Setting: This Goma multicenter cross-sectional study was carried out from February 1 st to March 3 rd , 2016.Subjects: Data on nutritional status among 583 HIV-infected patients on ART were measured using Body Mass Index as a proxy. Food insecurity was the primary independent variable and was measured using the Household Food Insecurity Access Scale. The prevalence of under nutrition and food insecurity was also estimated. A logistic regression model was used to identify the relationship between under nutrition and food insecurity, adjusted for other covariates. Results:The prevalence of food insecurity in the study group was 91.3% (95% CI: 89.0 -93.6%). The prevalence of undernutrition was 24.1% (95% CI: 20.6-27.6%).Nineteen percent of respondents were non-adherent (95% CI: 15.9% -22.3%). Only two percent have received a nutritional support during the previous month. Being household food insecure (AOR = 4.47, 95% CI: 1.35 -14.78) and living in a household with low socio-economic status (AOR = 2.02, 95% CI: 1.10 -3.69) were significantly associated with under nutrition. Conclusion:This study measured a high prevalence of food insecurity in Goma. The study highlight the negative impact of food insecurity on undernutrition and how the situation is exacerbated by the presence of HIV.Further studies are suggested to assess nutritional status with a high validity (sensitivity & specificity) way in HIV-infected patient on ART in this setting. Congo, remains unacceptably high. A major contributing factor is that over 800 million people remain chronically undernourished globally, and the HIV epidemic largely overlaps with populations already experiencing low diet quality and quantity. Malnutrition, and more specific under nutrition, is generally associated with increased mortality among HIV infected individuals initiating Antiretroviral Therapy (ART) [1,2].

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Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa

Cited by 19 publications

References 34 publications

A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS

A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS

Risk Factors for Delayed Initiation of Combination Antiretroviral Therapy in Rural North Central Nigeria

Food insecurity and undernutrition in treated HIV patients a (post-) conflict setting: A cross sectional study from Goma, Eastern Democratic Republic of Congo

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