Tesfamariam Kokeb, Baraki Negga, Kedir Haji
College of Medicine and Health Sciences, Department of Public Health, Ambo University, P.O. Box 21115, Ambo, Ethiopia.
School of Public Health, Haramaya University, Harar, Ethiopia.
BMC Res Notes. 2016 Dec 20;9(1):512. doi: 10.1186/s13104-016-2313-y.
Human immunodeficiency virus (HIV) compromises the nutritional status of infected individuals and in turn, malnutrition worsens the effects of the infection itself by weakening the immune system consequently accelerating disease progression and death. However, few studies have examined the association between nutritional status at antiretroviral therapy (ART) initiation and early mortality. Therefore, this study assesses pre-ART nutritional status and other baseline characteristics and mortality among adult patients on ART at Fiche Hospital, Ethiopia.
A retrospective cohort study was conducted among 489 ART enrolled adult patients between August 01, 2006 and September 30, 2013 in Fiche Hospital. Study participants were selected by using systematic random sampling method. Actuarial table was used to estimate survival of patients after ART initiation and log rank test was used to compare the survival curves. Cox proportional-hazard regression was used to determine independent predictors of time to death.
Most of the study subjects were females 254 (51.9%). A total of 489 patients were included in the analysis, of whom 87 died during a median study follow-up of 22 months. The estimated mortality among malnourished was 21, 28, 33, and 38% at 5, 10, 15, and 25 months respectively with mortality incidence density of 5.63 deaths per 100 person years. The independent predictors of mortality were: BMI <18.5 kg/m (AHR = 5.4 95% CI 3.03-9.58), baseline ambulatory functional status (AHR = 3.84; 95% CI 2.19-6.74), bedridden functional status (AHR = 4.78; 95% CI 2.14-10.65), WHO clinical stage III (AHR 2.21; 95% CI 1.16-4.21), WHO clinical stage IV (AHR 4.05; 95% CI 1.50-10.97) and CD4 count less than 200 cells/μl (AHR = 2.95; 95% CI 1.48-5.88), two and more opportunistic infections (AHR 2.30; 95% CI 1.11-4.75).
Undernutrition at the time of ART initiation was associated with increased risk of death, particularly during the first 3 months after ART initiation. Interventions to promote earlier HIV diagnosis and treatment and integrating nutrition counseling at all stages of ART implementation may improve ART outcomes in this vulnerable population.
人类免疫缺陷病毒（HIV）会损害感染者的营养状况，而营养不良反过来又会削弱免疫系统，从而加速疾病进展和死亡，进而加剧感染本身的影响。然而，很少有研究探讨抗逆转录病毒治疗（ART）开始时的营养状况与早期死亡率之间的关联。因此，本研究评估了埃塞俄比亚菲谢医院接受ART治疗的成年患者的ART治疗前营养状况、其他基线特征及死亡率。
对2006年8月1日至2013年9月30日期间在菲谢医院登记接受ART治疗的489名成年患者进行了一项回顾性队列研究。采用系统随机抽样方法选择研究参与者。使用精算表估计ART开始后患者的生存率，并使用对数秩检验比较生存曲线。采用Cox比例风险回归确定死亡时间的独立预测因素。
大多数研究对象为女性，共254人（51.9%）。共有489名患者纳入分析，其中87人在中位研究随访22个月期间死亡。营养不良者在5、10、15和25个月时的估计死亡率分别为21%、28%、33%和38%，死亡发病密度为每100人年5.63例死亡。死亡率的独立预测因素为：体重指数（BMI）<18.5kg/m（调整后风险比[AHR]=5.4，95%置信区间[CI]3.03 - 9.58）、基线非卧床功能状态（AHR = 3.84；95%CI 2.19 - 6.74）、卧床功能状态（AHR = 4.78；95%CI 2.14 - 10.65）、世界卫生组织（WHO）临床分期III期（AHR 2.21；95%CI 1.16 - 4.21）、WHO临床分期IV期（AHR 4.05；95%CI 1.50 - 10.97）、CD4细胞计数低于200个/μl（AHR = 2.95；95%CI 1.48 - 5.88）、两种及以上机会性感染（AHR 2.30；95%CI 1.11 - 4.75）。
ART开始时的营养不良与死亡风险增加相关，尤其是在ART开始后的前3个月。促进更早的HIV诊断和治疗以及在ART实施的各个阶段整合营养咨询的干预措施可能会改善这一弱势群体的ART治疗效果。
