Effects of undernutrition on treatment outcomes among adults living with HIV in Northwest Ethiopia: A longitudinal study

Ayalew, Animut Alebel

Effects of undernutrition on treatment outcomes among adults living with HIV in Northwest Ethiopia: A longitudinal study

Ayalew, Animut Alebel

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Publication Type:: Thesis
Issue Date:: 2023

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Field	Value	Language
dc.contributor.author	Ayalew, Animut Alebel
dc.date.accessioned	2023-10-17T00:33:24Z
dc.date.available	2023-10-17T00:33:24Z
dc.date.issued	2023
dc.identifier.uri	http://hdl.handle.net/10453/172713
dc.description	University of Technology Sydney. Faculty of Health.	en_US.UTF-8
dc.description.abstract	𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Undernutrition is one of the most common problems among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where both undernutrition and HIV are highly prevalent. In Ethiopia, although these interrelated conditions highly affect PLHIV, longitudinal studies evaluating the effects of undernutrition on treatment outcomes of this population are lacking. Therefore, the aim of this study was to assess the effects of undernutrition on the overall treatment outcomes of adults living with HIV (ALHIV) on antiretroviral therapy (ART) in Ethiopia. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: The first objective was addressed using a systematic review and meta-analysis. The remaining four objectives were addressed through a retrospective longitudinal study. Data for this study were obtained from the medical records of ALHIV, who received ART at Debre Markos Comprehensive Specialized Hospital, Ethiopia, between June 2014 and June 2020. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: Manuscript I found that undernutrition significantly increased the risk of mortality in ALHIV, while severely undernourished ALHIV were at higher risk of death compared to mildly undernourished ALHIV. Findings from Manuscript III (Manuscript II is a protocol) suggested that the adjusted risk of LTFU among undernourished participants was two times higher than in their well-nourished counterparts. Manuscript IV showed that undernutrition significantly shortened the time to develop OIs in adults living with HIV. Manuscript V also found a linear increment of weight over 24 months of follow-up. Rate of weight gain over time was lower in patients with advanced disease stage and working functional status, whereas weight gain rate was higher in male and underweight patients. Finally, findings from Manuscript VI showed that BMI improvement after ART initiation was strongly associated with lower mortality risk, regardless of BMI category. Additionally, patients who took a DGT-based ART regimen had a higher BMI increase rate over time, which aligns with possible positive effects, such as weight gain, of the DGT-based ART regimen in developing countries. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: The research presented in this thesis found that undernutrition significantly increases the risk of mortality, morbidity, and LTFU. In addition, undernutrition significantly reduced the time to develop OIs in this population. Moreover, a linear weight gain was observed throughout the follow-up, with a higher rate of increase in the first year. Lastly, a unit increase in BMI after ART initiation corresponded to an 18% reduction in mortality risk.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/172713/1/thesis.pdf
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	© 2023 Animut Alebel Ayalew
dc.rights	au.edu.uts.lib/cph
dc.title	Effects of undernutrition on treatment outcomes among adults living with HIV in Northwest Ethiopia: A longitudinal study	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Undernutrition is one of the most common problems among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where both undernutrition and HIV are highly prevalent. In Ethiopia, although these interrelated conditions highly affect PLHIV, longitudinal studies evaluating the effects of undernutrition on treatment outcomes of this population are lacking. Therefore, the aim of this study was to assess the effects of undernutrition on the overall treatment outcomes of adults living with HIV (ALHIV) on antiretroviral therapy (ART) in Ethiopia. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: The first objective was addressed using a systematic review and meta-analysis. The remaining four objectives were addressed through a retrospective longitudinal study. Data for this study were obtained from the medical records of ALHIV, who received ART at Debre Markos Comprehensive Specialized Hospital, Ethiopia, between June 2014 and June 2020. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: Manuscript I found that undernutrition significantly increased the risk of mortality in ALHIV, while severely undernourished ALHIV were at higher risk of death compared to mildly undernourished ALHIV. Findings from Manuscript III (Manuscript II is a protocol) suggested that the adjusted risk of LTFU among undernourished participants was two times higher than in their well-nourished counterparts. Manuscript IV showed that undernutrition significantly shortened the time to develop OIs in adults living with HIV. Manuscript V also found a linear increment of weight over 24 months of follow-up. Rate of weight gain over time was lower in patients with advanced disease stage and working functional status, whereas weight gain rate was higher in male and underweight patients. Finally, findings from Manuscript VI showed that BMI improvement after ART initiation was strongly associated with lower mortality risk, regardless of BMI category. Additionally, patients who took a DGT-based ART regimen had a higher BMI increase rate over time, which aligns with possible positive effects, such as weight gain, of the DGT-based ART regimen in developing countries. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: The research presented in this thesis found that undernutrition significantly increases the risk of mortality, morbidity, and LTFU. In addition, undernutrition significantly reduced the time to develop OIs in this population. Moreover, a linear weight gain was observed throughout the follow-up, with a higher rate of increase in the first year. Lastly, a unit increase in BMI after ART initiation corresponded to an 18% reduction in mortality risk.

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http://hdl.handle.net/10453/172713