Changes in nutritional, functional and immunological status of HIV-infected adults with antiretroviral therapy.

BACKGROUND: Literature has shown that there is vicious cycle between malnutrition and HIV infection. In Ethiopia, antiretroviral therapy (ART) was started about eight years back but, to the best of authors' knowledge, there was no published study that assessed treatment outcome indicators. OBJECTIVE: To assess the outcomes of ART from the perspective of nutritional, clinical, functional and immunological status. METHODS: A retrospective recored review was used to assess the nutritional status of adults before and after ART in Hawassa University referral hospital. This analysis included 358 living HIV positive adults who were on ART for 3 - 96 months. RESULTS: The mean age of the study participants was 33.75 +/- 9.12 years and the median duration of ART was 24 months (Inter-quartile range: 12, 36). After ART, cases with body mass index (BMI) < 18.5 kg/m2 dropped from 38% to about 20% and cases with CD4 count < 200/mm3 dropped from about 73% to about 9% (P < 0.0001 for each). However, there were 58 and 14 cases whose BMI and CD4 count were even below the Pre-ART levels, respectively. The regression line demonstrating an overall change in CD4 count showed a positive linear trend as the duration of ART increases but the change in BMI was a downward linear trend. In multiple linear regression, current nutritional status was found to have significant association with baseline low CD4 count, clinical stage III/ IV, low BMI and low meal frequency. Multiple logistic regression also demonstrated a significant association of low BMI after ART with low CD4 count before ART. With ART, decreased frequency of illness, baseline WHO clinical stage I/II and high BMI were independent predictors of improvement in functional status. CONCLUSION: Patients started on ART with low BMI, severely immunosuppressed and clinical stage III/IV illnesses were found to have poorer nutritional, functional and immunological response. This study provided another evidence to support the WHO recommendation on initiating ART before patients' nutritional, clinical and immunological statuses deteriorate. The nutritional care needs to be given more emphasis since the ART response was found to be unsatisfactory.