Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2023 Mar 24;18(3):e0283502. doi: 10.1371/journal.pone.0283502. eCollection 2023.
Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the most commonly affected region with HIV and malnutrition, a meta-analysis study that estimates the prevalence and correlates of undernutrition among adults living with HIV has not yet been conducted. The objective of this study was to determine the pooled prevalence of undernutrition and associated factors among adults living with HIV/AIDS in sub-Saharan Africa.
Studies published in English were searched systematically from databases such as PubMed, Google Scholar, and gray literature, as well as manually from references in published articles. Observational studies published from 2009 to November 2021 were included. The data extraction checklist was prepared using Microsoft Excel and includes author names, study area, publication year, sample size, prevalence/odds ratio, and confidence intervals. The results were presented and summarized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard. Heterogeneity was investigated using the Q test, I2, τ2, τ and predictive interval. STATA version 17 was used to analyze the data. A meta-analysis using a random-effects model was used to determine the overall prevalence and adjusted odds ratio. The study has been registered in PROSPERO with a protocol number of CRD42021268603.
In this study, a total of 44 studies and 22,316 participants were included. The pooled prevalence of undernutrition among adult people living with HIV (PLWHIV) was 23.72% (95% CI: 20.69-26.85). The factors associated with undernutrition were participants' age (AOR = 0.5, 95% CI: 0.29-0.88), gender (AOR = 2.08, 95% CI: 0.22-20.00), World Health Organization (WHO) clinical stage (AOR = 3.25, 95% CI: 2.57-3.93), Cluster of Differentiation 4 (CD4 count) (AOR = 1.94, 95% CI: 1.53-2.28), and duration of ART (AOR = 2.32, 95% CI: 1.6-3.02).
The pooled prevalence of undernutrition among adult PLWHIV in sub-Saharan Africa remained high. WHO clinical stage, CD4 count, duration of ART treatment, age, and sex were found to be the factors associated with undernutrition. Reinforcing nutrition counseling, care, and support for adults living with HIV is recommended. Priority nutritional screening and interventions should be provided for patients with advanced WHO clinical stages, low CD4 counts, the male gender, younger age groups, and ART beginners.
在感染艾滋病毒的患者中，营养不良（体重指数 < 18.5kg/m2）是一种常见的问题，也是住院的主要原因。尽管撒哈拉以南非洲是受艾滋病毒和营养不良影响最严重的地区，但尚未进行过评估成年人中艾滋病毒感染者营养不良患病率和相关因素的荟萃分析研究。本研究旨在确定撒哈拉以南非洲地区成年艾滋病毒感染者营养不良的总患病率和相关因素。
系统地从 PubMed、Google Scholar 和灰色文献等数据库以及已发表文章的参考文献中搜索发表在英文期刊上的研究。纳入 2009 年至 2021 年 11 月出版的观察性研究。使用 Microsoft Excel 编制数据提取清单，包括作者姓名、研究区域、出版年份、样本量、患病率/优势比和置信区间。结果按照系统评价和荟萃分析的首选报告项目（PRISMA）标准进行呈现和总结。使用 Q 检验、I2、τ2、τ 和预测区间来评估异质性。使用 STATA 版本 17 分析数据。使用随机效应模型进行荟萃分析以确定总体患病率和调整后的优势比。该研究已在 PROSPERO 中注册，注册号为 CRD42021268603。
在这项研究中，共纳入了 44 项研究和 22316 名参与者。成年人艾滋病毒感染者（PLWHIV）营养不良的总患病率为 23.72%（95%CI：20.69-26.85）。与营养不良相关的因素包括参与者的年龄（AOR=0.5，95%CI：0.29-0.88）、性别（AOR=2.08，95%CI：0.22-20.00）、世界卫生组织（WHO）临床分期（AOR=3.25，95%CI：2.57-3.93）、CD4 计数（AOR=1.94，95%CI：1.53-2.28）和抗逆转录病毒治疗（ART）持续时间（AOR=2.32，95%CI：1.6-3.02）。
撒哈拉以南非洲成年 PLWHIV 的营养不良总患病率仍然很高。WHO 临床分期、CD4 计数、ART 治疗持续时间、年龄和性别被发现与营养不良有关。建议加强对艾滋病毒感染者的营养咨询、护理和支持。应优先为 WHO 临床分期较晚、CD4 计数较低、男性、年龄较小和开始接受 ART 治疗的患者提供营养筛查和干预措施。
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