Use of Anthropometry in Monitoring the Nutritional and Health Status of Persons Living with HIV/AIDS

Abstract

Approximately 33 million persons are living with HIV/AIDS globally. Majority of these persons living with HIV/AIDS (PLWHA) reside in low and middle income countries where there is a scarcity of resources to deal with the magnitude of the problems associated with this HIV/AIDS pandemic. Weight loss is common feature of HIV/AIDS. In fact, the extent of this weight loss is a reasonable predictor of the morbidity and mortality among PLWHA. Malnutrition in PLWHA results from several factors. Among these are changes in metabolism resulting in increased utilization of nutrients, mal-absorption of nutrients associated with the frequent diarrheas and reduced dietary intakes due to nausea and vomiting, inability to swallow, and reduced access to nutritious foods. Malnutrition and HIV/AIDS act in a synergistic manner to accelerate and perpetuate the deleterious effect of the latter. HIV/AIDS is associated with deficiencies of zinc, vitamins B, C, E, proteins and calories. Consequently, PLWHA tend to exhibit clinical symptoms that are relatively similar to those associated with macro and micronutrient deficiencies. More recently, HIV/AIDS has been associated with unhealthy lipid profiles, especially among those on Highly Active Anti-Retroviral Therapy (HAART). While nutritional status cannot be measured directly, there are several anthropometric measures that can provide useful information on aspects of the nutritional status of PLWHA. To ensure accuracy of the data generated, anthropometric measures of nutritional status in PLWHA should be highly sensitive, specific and have good predictive values. They should also be simple to use, relatively inexpensive, acceptable to PLWHA, non-invasive, easy to interpret by all categories of workers in the health care system and applicable to all stages of the life cycle from infancy to adulthood. Among the anthropometric measures fulfilling these criteria are weight, height, weight-for-age (WA), weight-for-height (WH), body mass index (BMI), mid upper arm circumference (MUAC), skinfold thickness (SF), waist circumference (WC) and waist-hip ratio (WHR). Studies suggest that several of these anthropometric measures are associated levels of immune function (e.g., CD4+, CD8+ cells counts), blood proteins levels, and anaemia. Moreover, excess weight loss is predictive of both the morbidity and mortality among PLWHA. Anthropometric indices therefore provide useful tools for monitoring and evaluating the patho-physiological changes among PLWHA. While anthropometry allow us to monitor and evaluate changes in the nutritional status of PLWHA, its greatest benefit can only be realized as part of a comprehensive monitoring strategy that includes clinical assessment and biochemical tests.