Nutritional status of HIV/AIDS infected adults on HAART

[摘要] English: The aim of this study was to describe the nutritional status of HIV/AIDS infected patients on two HAART regimens. A convenience sample of 111 HIV infected patients on HAART from the Helen Joseph CCMT site in Johannesburg were included (55% on regimen 1 and 45% on regimen 2). HAART regimens differed, with regimen 2 including protease inhibitor (PI) based therapy and regimen 1 a non-PI based therapy. Dietary intake, biochemical markers, lifestyle and anthropometric variables, as well as associations between the above were determined.Dietary intake was determined by means of a 24-hour recall of usual intake and a short food frequency questionnaire. Weight, height, body composition (using bioelectrical impedance), waist and hip circumference measurements were obtained to calculate body mass index (BMI) and fat distribution. Lifestyle factors included smoking habits, alcohol consumption and physical activity levels. These variables were determined by means of a questionnaire completed by the researcher in a structured interview with each participant. Adequacy of diet was evaluated by comparing each patient's dietary intake to the recommended servings of the Food Guide Pyramid.Approximately 70% of patients on HAART consumed less than the required amount of fruit servings per day. Low vegetable consumption was reported, and 98% (regimen 1) and 94% (regimen 2) of patients did not consume the recommended number of servings of vegetables per day. Refined carbohydrates were consumed by 96% of patients on regimen 1 and 84% of patients on regimen 2. Salt intake in this population group was high, with 93.44% of patients on regimen 1 and 94% of patients on regimen 2 consuming added salt every day. Polyunsaturated fats like sunflower oils and margarines were used daily by 92% of patients on regimen 1 and 80% of patients on regimen 2. Full cream dairy products were used more frequently than low fat dairy products, due to the cheaper price. Peanut butter, a monounsaturated fat, was consumed relatively frequently (66% on regimen 1 and 62% on regimen 2).Medians for carbohydrates, proteins, fat and total energy intake were 310g, 77g, 54g and 7968kJ per day for the 1st line regimen group. In the 2nd line regimen group the medians were as follows: carbohydrates 220.5g, protein 68g, fat 45g and total energy 9233kJ per day. Total energy intake and carbohydrate intake as a percentage of total energy were significantly higher in patients on regimen 1. Dietary intakes of participant in this study showed that the quality of the diet was poor and not conducive to optimal nutritional status.Anthropometric information included BMI, body composition analysis, waist circumference and waist hip ratio. Median BMI of patients in the 1nd regimen (25.34kg/m2) group were significantly higher that that of patients in the 1st regimen group (22.80kg/m2) when comparing medians for BMI. BMI was above 25kg/m2 in 32.79% and 56% of patients on regimen 1 and 2 respectively. Approximately half of all patients in this study had waist circumference measurements above the recommended 80cm for females and 94cm for males. Undesirable waist to hip ratio measurements (for females >0.8 and for males >0.9) occurred in 95% of patients on regimen 1 and 66% of patients on regimen 2.Central obesity, increased BMI and high risk waist circumference and waist to hip ratios were evident in the majority of patients. High body fat percentages (more than 25%) were present in more than half of all the patients in this study. No significant differences were apparent when comparing anthropometric medians between the two groups. A large percentage of patients in this study were at risk of developing chronic diseases according to the results of the anthropometric assessments. The incidence of dyslipidemia in this population was high, with almost half of patients (47.92%) on regimen 2 and 34.43% of patients on regimen 1 having elevated tryglyceride levels. HDL levels were low in 43.75% of patients on regimen 1 and 22.95% of patients on regimen 2. High cholesterol levels were prevalent in 39% of patients on regimen 1 and 27.66% of patients on regimen 2. Patients on regimen 1 had significantly higher median cholesterol levels than patients on regimen 2. LDL cholesterol levels were elevated in a 60.66% of patients on regimen 1 and 52.08% on regimen 2. Despite all patients being on HAART, low CD4 counts (<500) and high viral loads (�?5) were prevalent in the majority of participants. In regimen 1, 80.8% of patients had a CD4 count below 500 and viral load above 25, while patients on regimen 2, 78.0% showed similar results.The majority of patients reported never smoking, with only 18.03% of participants on regimen 1 and 14.00% on regimen 2 reporting current smoking. Reported alcohol consumption was relatively low with 21.31% of patients on regimen 1 and 24.00% of regimen 2 currently using alcohol. Eighty two percent of patients on regimen 1 and 93.88% of patients on regimen 2 were sedentary.The nutritional status of the HIV infected patients on HAART in this study was found to be poor. Anthropometric measurements, lifestyle factors and biochemical markers indicated that these patients had an increased risk for developing chronic disease. HIV/AIDS and HAART are linked with metabolic abnormalities and associated chronic diseases. Poor nutrition exacerbates the risk and urgent interventions are required in this population.

[发布机构] University of the Free State