Effects of undernutrition on survival of human immunodeficiency virus positive children on antiretroviral therapy

Abstract

Background: The relationship between undernutrition and HIV is bidirectional, ultimately contributing to quality of life and survival of affected individuals. Ethiopia is a sub-Saharan nation influenced by both undernutrition and HIV. In Ethiopia, although individuals are often dually impacted, the effect of undernutrition on the survival of HIV positive children on anti-retroviral therapy (ART) has not been well investigated. Therefore, this study assessed the effect of undernutrition on survival rates of HIV positive children on ART in Amhara Regional State of Ethiopia.

Methods: An institution-based retrospective cohort study was conducted among 390 HIV positive children on ART from the 1st of January, 2012 to the 28th of February, 2017 in Amhara Regional State Referral Hospitals. A simple random sampling technique was used to select the study participants. Data were extracted by reviewing patients' ART intake and follow-up forms. Data were entered into Epi-Data Version 3.1, and analysis was done using STATA Version 13. The Kaplan-Meier survival curve was used to estimate the cumulative survival time of the sample. Log rank tests were employed to compare the survival time between different categories of explanatory variables. Bivariable and multivariable Cox proportional hazards models were fitted to identify predictors of mortality.

Results: Among the 390 records included in the final analysis, 9.7% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 4.4 per 100 child-years (95% CI: 3.2, 6.0) while undernourished children had a lower survival time than well-nourished children. Low hemoglobin level (AHR: 3.2, 95% CI: 1.4, 7.4), CD4 cell count or percent below the threshold (AHR: 5.2, 95% CI: 1.9, 14.1), severe stunting (AHR: 3.9, 95% CI: 1.7, 9.4), severe wasting (AHR: 3.0, 95% CI: 1.3, 6.9) and advanced disease stage (III and IV) (AHR: 2.6, 95% CI: 1.1, 6.6) were found to be predictors of mortality.

Conclusion: There was a high rate of mortality. A significant difference was observed in the survival rate of undernourished and well-nourished children. Low hemoglobin level, CD4 count or percent below the threshold, severe wasting, severe stunting, and advanced disease stage were found to be predictors of mortality.

Keywords: Anti-retroviral therapy (ART); Children; HIV; Mortality; Undernutrition.

Fig. 1

The Kaplan-Meier survival curves to compare survival time of HIV positive children on ART with different categories of nutritional status in Amhara Regional State referral hospitals, Northwest Ethiopia from January 1st, 2012- February 28th, 2017

Fig. 2

The Kaplan-Meier survival curves to compare survival time of HIV positive children on ART with different categories of hemoglobin level in Amhara Regional State referral hospitals, Northwest Ethiopia from January 1st, 2012- February 28th, 2017

Fig. 3

The Kaplan-Meier survival curves to compare survival time of HIV positive children on ART with different categories of WHO clinical staging in Amhara Regional State referral hospitals, Northwest Ethiopia from January 1st- February 28th, 2017

Fig. 4

The Kaplan-Meier survival curves to compare survival time of HIV positive children on ART with different categories of CD4 count or percent in Amhara Regional State referral hospitals, Northwest Ethiopia from January 1st- February 28th, 2017