Abstract
BackgroundUndernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA.MethodsA systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio.ResultsOf 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV.ConclusionThis review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.
Highlights
Undernutrition is one of the most common problems among people living with Human Immunodeficiency Virus (HIV), contributing to premature death and the development of comorbidities within this population
An additional 43 full texts were excluded for the following reasons: 17 studies did not report data on the outcome(s) of interest [52,53,54,55,56,57,58,59,60,61,62,63,64,65], eight studies reported only descriptive results [66,67,68,69,70,71,72,73,74,75,76], six studies were conference presentations [77,78,79,80,81,82], six studies were not conducted in Sub-Saharan Africa (SSA) [83,84,85,86,87,88], two studies focused on children [89, 90], two studies focused on pregnant women [91, 92], one study included only malnourished adults [93], and one was a review paper [94]
Subgroup analyses of effects of undernutrition on mortality The subgroup analyses of this review showed that severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% confidence intervals (CI): 1.9, 2.8) as compared to mildly undernourished adults living with HIV
Summary
Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. Human Immunodeficiency Virus (HIV) continues to be a significant global public health problem, with SubSaharan Africa (SSA) being the most significantly affected region [1, 2]. There is no cure for HIV, antiretroviral therapy (ART) suppresses viral replication and increases the CD4 counts sufficiently to improve the survival rates and quality of life [5] Despite these benefits, 23.3 million (62%) PLHIV were accessing ART in 2018 [4, 6] with low ART coverage in LMICs is mainly attributable to inaccessibility of health coverage [1]. 23.3 million (62%) PLHIV were accessing ART in 2018 [4, 6] with low ART coverage in LMICs is mainly attributable to inaccessibility of health coverage [1] Malnutrition refers to both undernutrition and overnutrition. This review focused on undernutrition, which is the most common form of malnutrition in LMICs
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