Abstract
BackgroundHIV 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).ObjectiveTo describe the nutritional parameters of antiretroviral therapy (ART) recipients (without nutritional support) with respect to CD4 count and virological failure.MethodsA 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.ResultsMedian [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.ConclusionIn 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.
Highlights
The human immunodeficiency virus (HIV) targets the immune system and weakens the surveillance by the body’s own defense system against cancer cells and infections, which in turns leads to susceptibility of HIV infected individuals to a wide range of infections normally cleared by the immune system of a healthy/immunocompetent individual [1]
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
In this resource-limited settings (RLS), with patients having about five years of antiretroviral therapy (ART)-experience, malnutrition appears to be driven mainly by a poor body mass index (BMI), indicating that about one of ten patients falls within this severe condition
Summary
The human immunodeficiency virus (HIV) targets the immune system and weakens the surveillance by the body’s own defense system against cancer cells and infections, which in turns leads to susceptibility of HIV infected individuals to a wide range of infections normally cleared by the immune system of a healthy/immunocompetent individual [1]. Malnutrition is one of the major complications of HIV infection [3] and has been recognized under the banner of ‘wasting syndrome’ as a significant prognostic factor of disease progression [4]. Under-nutrition impairs the immune system mechanism and weakens the host response against microorganisms. The consequence of this impairment is an increase in both incidence and severity of infections within the affected individual [6, 7]. Regarding the classification of global acute malnutrition (GAM) at population-level, the United Nations guidelines recommend that a threshold above 10% of GAM is considered as a high-level of severity, which in turns refers to a high public health concern that requires immediate actions [9]. 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)
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