HIV: Why standard care should include malnutrition interventions
Scientists have confirmed that malnutrition is associated with an increased risk of death among people living with HIV, as a result they now recommend strategic inclusion of malnutrition interventions into the standard HIV care.
Their recommendation is based on findings of a latest study, which aimed to determine the prevalence and risk factors of underweight and overweight, i.e., obesity, in those living with HIV. The study involved 2,129 patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) between January 2013 to December 2018.
KIULARCO is a cohort study utilizing routine data collected at the Chronic Disease Clinic of Ifakara (CDCI), the HIV care and treatment center of the St. Francis Referral Hospital in Ifakara, Morogoro region in rural south-western Tanzania since 2004.
The study, published on PLoS One – August 22, 2023, was led by scientists from Ifakara Health Institute, the Swiss PTH and the University of Basel. The scientists found a double burden of malnutrition, with underweight as an independent predictor of mortality among those living with HIV.
“We found a double burden of malnutrition in this rural HIV cohort of Tanzania with important implications for clinical outcomes. Interventions to address various states of malnutrition and their underlying causes should be considered in HIV clinics,” wrote the scientists.
Overweight – a significant risk factor
Being overweight is a significant risk factor for heart disease, and people living with HIV are increasingly reporting health issues related to increased body weight. However, there is still limited data from rural sub-Saharan Africa, where malnutrition usually manifests as both over- and undernutrition.
This study is one of the few that attempted to determine the prevalence and risk factors of underweight and overweight or obesity in those living with the virus in rural Tanzania, stated the scientists.
“The objectives of this study were to determine the prevalence of underweight and overweight/obesity, trends of body mass index (BMI), factors associated with follow-up BMI, and the association between time-updated BMI and death/loss to follow-up (LTFU) among adults initiated on ART in rural Tanzania.”
More studies needed
Furthermore, the scientists called for more studies with longer follow-up periods to investigate a possible association between being overweight and cardiovascular endpoints and mortality in sub-Saharan Africa.
“In people living with HIV, the interaction between HIV and body weight is complex, with low BMI being common in patients with untreated HIV infection and opportunistic infections…While our data suggest that higher BMI is associated with improved survival, more research is needed, particularly in the context of earlier initiation of antiretroviral treatment since 2018 and newer antiretrovirals like dolutegravir being introduced.”
The contributors to the study and article include Aneth Kalinjuma, Hannah Hussey, Getrud Mollel, Maja Weisser and the KIULARCO study group from Ifakara Health Institute. From the Swiss TPH, contributors include Emilio Letang, Tracy Glass, Daniel Paris and Fiona Vanobberghen. Manuel Battegay from the University of Basel also contributed to the study and the publication.
KIULARCO is a cohort study run collaboratively by Ifakara and partners – The Ministry of Health; St. Francis Referral Hospital; and the Swiss TPH – utilizing routine data collected at the Chronic Disease Clinic of Ifakara (CDCI), the HIV care and treatment center of the St. Francis Referral Hospital in Ifakara, Morogoro region in rural south-western Tanzania since 2004.
Close to 9000 patients have consented to contribute their clinical data to address questions on treatment outcome, important opportunistic infections and co-morbidities. This has resulted into considerable improvements of the services with multiple lessons now benefiting the national and international efforts against HIV and co-morbidities.
Currently, about 3500 patients are under regular follow-up on an outpatient basis and about 90% of these are taking an antiretroviral treatment.
>> Learn more on Ifakara research platforms here.
HIV, whose long form is “human immunodeficiency virus,” is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. It is spread by contact with certain bodily fluids of a person with the virus.
If left untreated, HIV can lead to the disease itself which is AIDS – acquired immunodeficiency syndrome. The human body can’t get rid of HIV and no effective HIV cure exists at the moment. However, effective treatment with HIV medicine – antiretroviral therapy or ART – is available.
If taken as prescribed, ART can reduce the amount of HIV in the blood – technically known as “the viral load” to a very low level. When viral suppression happens, a standard lab can’t detect the virus. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit it.
>> Learn more on HIV & AIDS here.