在撒哈拉以南非洲地区，营养不足对艾滋病毒感染者成人的死亡率和发病率的影响：系统评价和荟萃分析。

Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis.

机构信息

College of Health Science, Debre Markos University, Debre Markos, Ethiopia.

School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

出版信息

BMC Infect Dis. 2021 Jan 4;21(1):1. doi: 10.1186/s12879-020-05706-z.

BACKGROUND

Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA.

METHODS

A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I statistics. Publication bias was assessed using Egger's and Begg's tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio.

RESULTS

Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV.

CONCLUSION

This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.

背景

在 HIV 感染者中，营养不良是最常见的问题之一，这导致了他们过早死亡和合并症的发生。在撒哈拉以南非洲（SSA），这些经常相互关联的情况的影响在一系列零散和不确定的研究中显现出来。因此，本综述检查了营养不良对 SSA 中 HIV 感染者的死亡率和发病率的综合影响。

方法

从 PubMed、EMBASE、CINAHL 和 Scopus 数据库中进行了系统的文献检索。所有报告 SSA 中 HIV 感染者营养不良对死亡率和发病率影响的观察性研究都被包括在内。使用 Cochrane Q 检验和 I 统计量评估纳入研究之间的异质性。使用 Egger 和 Begg 检验在 5%的显著性水平下评估发表偏倚。最后，使用随机效应荟萃分析模型估计总体调整后的危险比。

结果

在 4309 项确定的研究中，有 53 项文章符合纳入标准并被纳入本综述。其中，有 40 项研究可用于荟萃分析。对 23 项队列研究的荟萃分析表明，营养不良显著增加了 HIV 感染者的死亡率风险（AHR：2.1，95%CI：1.8，2.4），而与轻度营养不良的 HIV 感染者相比，严重营养不良的 HIV 感染者死亡风险更高（AHR：2.3，95%CI：1.9，2.8）。此外，十项队列研究的汇总估计表明，营养不良显著增加了 HIV 感染者发生结核病的风险（AHR：2.1，95%CI：1.6，2.7）。