A Prospective Study To Assess The Factors Affecting Nutritional Status Of People Living With Hiv/Aids (Plha) Receiving Anti-Retroviral Therapy (Art)

Abstract

Background: The current HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) pandemic is a worldwide concern, the impact of which is expected to be felt over the years ahead, with critical public health implications. Focus on improving nutrition in HIV/AIDS patients is vital and the need of the hour. This is because, proper nutrition not only optimizes existing immune system function, but can significantly reduce the incidence of HIV-related complications and improves the patient’s quality of life. Nutritional management among PLHA is hence an essential but often neglected element in the HIV continuum of care and efforts need to be invested in studying as well as understanding the complicated web of associated factors. The main aim of the study was to assess the nutritional status and socio-demographic factors of ART-Naïve PLHA and their association, by prospectively following them for one year. Materials and Methods: A Prospective study was carried out among ART-naive PLHA, registered in five Institutional ART centers in Pune, Maharashtra and followed up for one year from their inclusion date in the study. Accounting for 15% loss-to-follow-up, the sample size was estimated to be 430. Systematic random sampling was employed to achieve the target sample size from all five ART centers. Ethical clearance was obtained from the Institutional Ethical Clearance Committee. All patients were recruited for the study on a voluntary basis, confidentiality was ensured in every step. Data was collected by means of personal interview and anthropometric measurements and relevant blood investigations were carried out as per study protocol. Results: Overall, 430 participants were enrolled in the study, and baseline data were collected from them. However, only 378 remained till the end of the study period (13 months) and were included in the final analysis. With the mean age of the study cohort of 41yrs, and even after one year of treatment, undernutrition in our study was at 34.9%, anaemia at 59.9%, low albumin at 12.9%, low total protein at 13.8%, which were higher in spite of regular treatment and monitoring. 72% were consuming an inadequate diet. The majority, 57.1%, had a poor Quality of life (QoL) index, while 31.5% and 11.5% had good and excellent QoL indices, respectively and the majority, 52.9% showed food insecurity. Chi-square test of independence was used to test the association which showed, No or same Job, decreased or no income, food insecurity, poor quality of life, decreased level of haemoglobin, low before-after perceived health status, after 1 year of ART were significant predictors of low nutrition status. Also, female respondents were significantly at higher risk of low nutrition status while on ART. The study also showed the majority of the PLHA practiced wrong cooking/poor eating habits and consumed unpasteurized milk. Few of the Water, sanitation and hygiene (WaSH) and food consumption patterns showed alarming practices which needed to be changed. These practices are the “Art of preserving life” in this century where in communicable diseases are at high, especially in developing nations. About 31% of the subjects were found to be overweight/obese, with 32% being tobacco users and 8.31% alcohol drinkers, flagging the need to implement preventive measures for Non communicable diseases (NCDs) even among PLHAs. Conclusion: Poor/no income, job insecurity, food insecurity, poor QoL, anaemia at the end of one year of ART, female gender and those living in urban areas were significant predictors of undernutrition among PLHA. Synergistic effects of malnutrition, food insecurity, poor diet and health status influence poor outcomes in the already compromised household conditions due to increased financial constraints with superimposed emotional breakdown. Hence, even a tiny fraction in weight loss would result in significant morbidity and decreased survival rate among PLHA. Study findings also recommended PLHA to follow good WaSH practices and cooking/eating habits, as these factors act synergistically with other factors to affect the holistichealth of PLHA. The study findings also indicate the incorporation of early screening for NCD risk factors among PLHA, to prevent and manage the same at the earliest, before it can aggravate the already compromised immune status among PLHA