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Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study

BACKGROUND: 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 t...

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Autores principales: Tesfamariam, Kokeb, Baraki, Negga, Kedir, Haji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175315/
https://www.ncbi.nlm.nih.gov/pubmed/27998310
http://dx.doi.org/10.1186/s13104-016-2313-y
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author Tesfamariam, Kokeb
Baraki, Negga
Kedir, Haji
author_facet Tesfamariam, Kokeb
Baraki, Negga
Kedir, Haji
author_sort Tesfamariam, Kokeb
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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(2) (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). CONCLUSIONS: 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.
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spelling pubmed-51753152016-12-28 Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study Tesfamariam, Kokeb Baraki, Negga Kedir, Haji BMC Res Notes Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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(2) (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). CONCLUSIONS: 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. BioMed Central 2016-12-20 /pmc/articles/PMC5175315/ /pubmed/27998310 http://dx.doi.org/10.1186/s13104-016-2313-y Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tesfamariam, Kokeb
Baraki, Negga
Kedir, Haji
Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title_full Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title_fullStr Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title_full_unstemmed Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title_short Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study
title_sort pre-art nutritional status and its association with mortality in adult patients enrolled on art at fiche hospital in north shoa, oromia region, ethiopia: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175315/
https://www.ncbi.nlm.nih.gov/pubmed/27998310
http://dx.doi.org/10.1186/s13104-016-2313-y
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