Academic journal article Journal of Health Population and Nutrition

Nutritional Status of HIV-Infected Patients during the First Year HAART in Two West African Cohorts

Academic journal article Journal of Health Population and Nutrition

Nutritional Status of HIV-Infected Patients during the First Year HAART in Two West African Cohorts

Article excerpt

Background

In sub-Saharan Africa (SSA), malnutrition is endemic and affects 12-26% of the populations of Mali and Senegal [1]. The term 'malnutrition' refers to undernutrition and/or overnutrition. However, in the present study, we focused on malnutrition as a state of undernutrition. Malnutrition results from two major processes, insufficient dietary intake - namely undernutrition - and/or inflammatory activity [2]; that both compromise immune functions [3,4]. In SSA, the HIV epidemic has been surperimposed onto prevalent nutritional deficits. The infection is also a cause of malnutrition through dietary reduction, nutrient malabsorption, inflammation and metabolic disturbances. When coupled, undernutrition and HIV induce a vicious cycle that hastens disease progression and increases mortality [5]. Despite increased access to HAART, poor nutritional status persists [6] and continues to be associated with negative health outcomes [7-9].

Low BMI reflects low energy stores and chronic energy deficiency [10,11]. Between 19-63% of patients living with HIV/AIDS (PLA) in SSA display a low BMI at HAART initiation [9,12-14]. Low BMI strongly predicts disease progression, therapeutic failure and mortality [12,14,15]. More importantly, in low and middle income countries (LMIC) weight loss in the first months of treatment is associated with increased side effects [16,17], poor treatment outcomes and mortality [7,9,13,15].

In PLA, anemia is highly frequent, affecting up to 95% of those in advance stages of the disease [15,18]. Its etiology is multifactorial, HIV-associated cytokine production and viral activity lead to reduced hematopoiesis [19]. In addition, the infection aggravates micronutrient deficiencies that cause anemia [20]. In treated patients, anemia has been associated with excess mortality, poor treatment outcomes [18,21] and excess side effects [22].

In LMIC, up to 55% of PLA suffer from hypoalbuminemia [23-25]. Albumin is a negative acute phase protein (APP) and biological marker of nutritional status [11]. Its synthesis and decline are closely linked to protein and energy intake adequacy, as well as ongoing inflammation consequent to malnutrition and/or HIV infection [26]. Due to its correlation with CD4, both pre and post ART initiation, and its association with mortality despite HAART [23,25,27], hypoalbuminemia has been proposed as a marker of disease progression and treatment response in LMIC [28-30]. Furthermore, albumin may influence the pharmacokinetics [31,32] and exacerbate the side effects of ART [16].

Despite a high prevalence of malnutrition in treated PLA in LMIC, few studies have described post HAART nutritional trajectories in these patients. In two different West African contexts, we examined malnutrition amongst individuals in their first year of treatment by investigating the association between nutritional markers at treatment initiation by and examining nutritional trajectories post HAART.

Methods

Study design and population

ATARAO (Appuyer le Traitement AntiRétroviral en Afrique de l'Ouest) was a one-year cohort that aimed at identifying the determinants of therapeutic success in treatment naïve PLA at two hospitals and two community centers in Bamako and Sikasso, Mali. Attending physicians at participating sites consecutively invited all patients who qualified for ART initiation during the recruitment period to join the cohort. Details concerning inclusion criteria are contained in Table 1. Participants were interviewed at baseline (time of HAART initiation) and invited to return every 3 months thereafter. Informed consent was obtained at baseline. A compensation of???4 US$ for transportation was given at every interview. This study was approved by Malian (Health Ministry) and Canadian (Montreal University Hospital Centre - CHUM) ethics committees.

Detailed methodology of the ANRS 1290/1215 (Agence Nationale de Recherche sur le Sida) has been described elsewhere [33]. …

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