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Determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a case-control study design
BMC Nutrition Pub Date : 2019-03-01 , DOI: 10.1186/s40795-019-0284-9
Ayenew Negessie 1 , Dube Jara 2 , Mekaunint Taddele 2 , Sahai Burrowes 3
Affiliation  

A complex and negatively reinforcing relationship exists between infection with Human Immune Deficiency Virus (HIV) and malnutrition. HIV-induced immune impairment and its resulting opportunistic infections (OIs) can lead to malnutrition and nutritional deficits, can, in turn, hasten the progression of HIV infection and reduce chances of survival. The determinants of undernutrition among patients receiving antiretroviral therapy (ART) is poorly understood in Ethiopia, despite a high prevalence of food-insecurity that overlaps with a generalized HIV/AIDS epidemic. Therefore, this study aimed to assess determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos Referral Hospital in Northwest Ethiopia. We conducted an institution-based, unmatched, case-control study with 636 adult patients receiving antiretroviral therapy. We randomly selected 212 patients with poor nutritional outcomes (cases) and 424 without undernutrition (controls) and then conducted a chart review to collect information on their treatment, socio-economic, and demographic background. Data were analyzed using bivariable and multivariable logistic regression to identify factors associated with under nutrition. We found that greater age (AOR = 1.02, 95% CI: 1.01,1.05), fair or poor adherence (AOR = 2.77, 95% CI: 1.40, 5.50 and AOR = 4.72, 95% CI: 1.92, 11.6), and the presence of OIs (AOR = 1.70, 95% CI: 1.12, 2.52), anemia (AOR = 1.81, 95% CI: 1.07, 3.07), or eating problems (AOR = 3.40, 95% CI: 2.27, 5.10), were all independently and positively associated with under nutrition. Starting treatment with a medium or low CD4 count was protective (AOR = 0.61, 95% CI: 0.39, 0.96 and AOR = 0.49, 95% CI: 0.27, 0.88). Having social support (AOR = 0.64, 95% CI: 0.43, 0.95), and having a source of informal care-giving (AOR = 0.48, 95% CI: 0.27, 0.84), reduced the odds of undernutrition. Our findings support calls for treating HIV infection early and aggressively, while closely monitoring patients for opportunistic infections that might affect eating and drug side effects that may affect appetite. The role of disclosure, peer-caregivers and age in preventing undernutrition should be explored in future research.

中文翻译:

埃塞俄比亚西北部 Debre Markos 转诊医院接受抗逆转录病毒治疗的成年患者营养不良的决定因素:病例对照研究设计

人类免疫缺陷病毒 (HIV) 感染与营养不良之间存在一种复杂的负强化关系。HIV 引起的免疫损伤及其导致的机会性感染 (OIs) 可导致营养不良和营养不足,进而加速 HIV 感染的进展并降低生存机会。埃塞俄比亚对接受抗逆转录病毒治疗 (ART) 的患者营养不良的决定因素知之甚少,尽管粮食不安全的高发率与普遍的艾滋病毒/艾滋病流行重叠。因此,本研究旨在评估在埃塞俄比亚西北部的 Debre Markos 转诊医院接受抗逆转录病毒治疗的成年患者营养不良的决定因素。我们进行了以机构为基础的、无与伦比的、636 名接受抗逆转录病毒治疗的成年患者的病例对照研究。我们随机选择了 212 名营养不良的患者(病例)和 424 名没有营养不良的患者(对照组),然后进行图表审查以收集有关他们的治疗、社会经济和人口背景的信息。使用双变量和多变量逻辑回归分析数据,以确定与营养不足相关的因素。我们发现年龄越大 (AOR = 1.02, 95% CI: 1.01,1.05),依从性一般或差(AOR = 2.77, 95% CI: 1.40, 5.50 和 AOR = 4.72, 95% CI: 1.92, 11.6),以及存在 OIs (AOR = 1.70, 95% CI: 1.12, 2.52)、贫血 (AOR = 1.81, 95% CI: 1.07, 3.07) 或饮食问题 (AOR = 3.40, 95% CI: 2.27, 5.10),都与营养不良独立且正相关。以中等或低 CD4 计数开始治疗具有保护性(AOR = 0.61, 95% CI: 0.39, 0.96 和 AOR = 0.49, 95% CI: 0.27, 0.88)。拥有社会支持 (AOR = 0.64, 95% CI: 0.43, 0.95) 和非正式护理来源 (AOR = 0.48, 95% CI: 0.27, 0.84) 降低了营养不良的几率。我们的研究结果支持早期积极治疗 HIV 感染的呼吁,同时密切监测可能影响饮食的机会性感染和可能影响食欲的药物副作用。未来的研究应探讨信息披露、同伴照顾者和年龄在预防营养不良中的作用。降低了营养不良的几率。我们的研究结果支持早期积极治疗 HIV 感染的呼吁,同时密切监测可能影响饮食的机会性感染和可能影响食欲的药物副作用。未来的研究应探讨信息披露、同伴照顾者和年龄在预防营养不良中的作用。降低了营养不良的几率。我们的研究结果支持早期积极治疗 HIV 感染的呼吁,同时密切监测可能影响饮食的机会性感染和可能影响食欲的药物副作用。未来的研究应探讨信息披露、同伴照顾者和年龄在预防营养不良中的作用。
更新日期:2019-03-01
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