ORIGINAL ARTICLE
Public Health and Preventive Medicine Archive (PHPMA) 2017.
Volume 5.
Number 2: 147-151
E-ISSN: 2503-2356
Predictors of improved nutritional status among HIV/AIDS patients who received antiretroviral therapy (ART) at Sanglah General Hospital Denpasar Gusti Ayu Eka Utarini,1,2* Anak Agung Sagung Sawitri,2,3 Ketut Tuti Parwati Merati2,4 ABSTRACT Background and purpose: Antiretroviral therapy (ART) is associated with improved nutritional status among HIV/AIDS patients.
This study aims to examine proportion, median time, incidence rate, and predictors of improved nutritional status among HIV/AIDS patients who received ART at Sanglah General Hospital Denpasar.
Methods: A restrospective cohort study was conducted in Denpasar City.
A total of 207 medical records of HIV/AIDS patients who received ART between 1st of January 2012 and 30th of June 2015 were included in the study.
Kaplan Meier analysis was performed to calculate incidence rate and median time of improved nutritional status among HIV/AIDS Sociodemographic characteristics and clinical variables included body mass index (BMI), body weight, haemoglobin level.
CD4 count.
HIV clinical stadium.
ART regiments, and opportunistic infections (OI.
Data were analysed using cox proportional hazard model to identify predictors of improved nutritional status among HIV/AIDS patients.
Results: As many as 65.
22% of HIV/AIDS patients who received ART experienced an improvement in their nutritional status with the incidence rate of 9.
1 per 100 person months and median time of 1 months.
Multivariate analysis showed that predictors of improved nutritional status were BMI at ART initiation (AHR=1.
95%CI: 1.
HIV clinical stadium (AHR=1.
95%CI: 1.
CD4 count at ART initiation (AHR=0.
95%CI: 0.
and the presence of diarrhoea (AHR=1.
95%CI: 1.
Conclusions: Predictors of improved nutritional status among HIV/ AIDS patients who received ART were BMI.
HIV clinical stadium.
CD4 count and diarrhoea.
Keywords: predictors, nutritional status.
ART.
HIV/AIDS.
Bali Midwifery Department.
Denpasar Health Polytechnic Bali.
Public Health Postgraduate Program Udayana University.
Department of Community and Preventive Medicine Faculty of Medicine Udayana University.
Department of Internal Medicine Faculty of Medicine Udayana University Correspondence to:
Gusti Ayu Eka Utarini.
Midwifery Department.
Denpasar Health Polytechnic Bali utarini@gmail.
INTRODUCTION
Following the discovery of highly active antiretroviral therapy (HAART).
HIV/AIDS mortality rate decreased significantly and the quality of life of HIV/AIDS patients was improved.
UNAIDS
reported that between 2005 and 2014, there was a 35% decrease of HIV/AIDS mortality rate.
1 An indicator used to predict the efficacy of antiretroviral therapy (ART) is nutritional status of HIV/AIDS 2-7 Studies have shown that patientsAo conditions prior to ART initiation were associated with nutritional status improvement during the ART These conditions are adequacy of nutrient intake,3,8,9 CD4 count,10 the presence of opportunistic infections (OI.
, income level, 11 and body mass index (BMI).
12 However, other studies showed that CD4 count,2,13 cigarette smoking, alcohol and food consumption,13 clinical stadium,14 and ART regimen15 are not associated or negatively associated with nutritional status among HIV/AIDS patients who received ART.
In addition, other studies also found that education level11,16 of HIV/AIDS patients are not associated with nutritional status among HIV/AIDS patients who received ART.
Sanglah General Hospital Denpasar is a centre for ART services in Bali Province with an average new patients receiving ART is 30 patients per month.
A study among 110 new HIV/AIDS patients at Sanglah General Hospital between October and December 2012 found that the median BMI was 18.
4 kg/m2 and as many as 9% experienced wasting syndrome.
17 This study also showed that the majority of HIV/AIDS patients who initiated ART at Sanglah Hospital were malnourished.
Aim of this study is to examine median time, incidence rate, and predictors of improved nutritional status among HIV/AIDS patients who received ART at Sanglah General Hospital Denpasar.
METHODS
A retrospective cohort study using survival analysis was conducted on 207 medical records of patients who initiated ART between January 2012 and June 2015 at VCT Clinic Sanglah General Hospital Denpasar.
Selection criteria included patients aged at least 18 years and malnourished with BMI of ORIGINAL ARTICLE <18.
5 kg/m2 at the ART initiation.
In addition, to be included patient should have had at least one follow up visit after the ART initiation.
Pregnant patients and those with incomplete medical record were Improved nutritional status was defined as when patients reached BMI of Ou18.
5 kg/m2.
All predictor variables were measured at the time of ART initiation.
Those variables were sex, age, address, education level, employment, waiting time for ART.
BMI, body weight, haemoglobin level.
CD4 count.
HIV clinical stadium, opportunistic infections and ART Median time of improved nutritional status was determined using Kaplan Meier analysis.
Association between predictors and improved nutritional status was assessed using cox regression.
The study protocol has been approved by Human Table 1 Research Ethics Committee of Faculty of Medicine Udayana University/Sanglah General Hospital.
RESULTS
Table 1 presents the characteristics of patients.
The median age for ART initiation was 32 years.
many as 55.
56% of patients were male, 48.
79% were senior high school graduates, 60.
39% were married, 05% were government employees, private sectors or entrepreneur, and 55.
07% were living in Denpasar or Badung.
The median time of waiting time before ART was 39 days, where as many as 10% of patients were initiated ART in 2014.
A total of 135 patients .
22%) reached the normal nutritional status while 52 patients .
were still malnourished.
In addition, 20 patients Sociodemographic characteristics of HIV/AIDS patients Characteristics n=207 Median IQR Male Female Age at ART initiation Sex Education No school Primary Junior high Senior high Tertiary education Not married Married Unemployed, labourer, farmer Government worker, private sector, entrepreneur Outside Denpasar/Badung Denpasar/Badung Median IQR Marital Status Employment Address Waiting time for ART .
Year of ART initiation Public Health and Preventive Medicine Archive 2018.
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ORIGINAL ARTICLE
Table 2 Crude hazard ratio (CHR) for predictors of improved nutritional status Variables at ART initiation Patients who achieved normal nutritional status Time at risk .
Incidence rate .
person mont.
Crude hazard ratio (CHR) 95%CI Age .
Sex Male Female OJunior high OuSenior high Not Married Married Education Marital Status Employment Unemployed, labourer, farmer Government worker, private sector, driver, entrepreneur Denpasar/Badung Outside Denpasar/ Badung Waiting time for ART Address Opportunistic infections Candidiasis No candidiasis Oral candidiasis Oesophageal candidiasis TB .
Diarrhoea .
CD4 .
Hemoglobin .
85- 5.
HIV clinical stadium
I&II
i 09- 6.
BMI (Media.
Body weight ART regiments Contain TDF Contain AZT Others Table 3 Adjusted hazard ratio (AHR) for predictors of improved nutritional status Variables at ART initiation Adjusted hazard ratio (AHR) 95%CI p value BMI increment Ou1 kg/m <0.
Severe clinical stadium 02Ae2.
Presence of diarrhoea CD4 count >50 sel/m Public Health and Preventive Medicine Archive 2018.
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ORIGINAL ARTICLE
likely to achieve an improved nutritional status (AHR=0.
95%CI: 0.
DISCUSSION