|Year : 2022 | Volume
| Issue : 4 | Page : 323-327
Short term impact of antiretroviral therapy (ART) on nutritional status and quality of life (QOL) of retropositive patients
Aaditya Sharma, Monica Gupta, Jaspreet Kaur, Sarabmeet S Lehl
Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
|Date of Submission||26-Feb-2022|
|Date of Decision||16-Mar-2022|
|Date of Acceptance||18-Mar-2022|
|Date of Web Publication||17-Mar-2023|
Dr. Monica Gupta
Department of General Medicine, Level 4 D Block, Government Medical College and Hospital, Sector 32, Chandigarh - 160 030
Source of Support: None, Conflict of Interest: None
Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is usually associated with adverse health outcomes in terms of poor nutritional status and impaired quality of life (QOL) often leading to marked morbidity and mortality. Early initiation of antiretroviral therapy (ART) can have a major impact on the overall well-being of HIV-inflicted patients helping them to live a functionally independent life.
Aim: The purpose of our study was to determine the short-term impact of ART on the QOL and nutritional status of retropositive patients.
Methods: A prospective study was conducted in the Department of General Medicine, Functionally Integrated Anti-retroviral Therapy (FIART) area on 60 ART-naive retropositive patients who were assessed for improvement in nutritional status and QOL domains after 3 months of ART.
Results: The patients were assessed before and after the initiation of therapy and showed improvement in the anthropometric parameters along with improvement in the QOL which was assessed using the six domains using the World Health Organization (WHO) questionnaire. Both the parameters were compared on the basis of gender, education, and socioeconomic class. Male patients with higher education and those belonging to higher socioeconomic strata showed better improvement as compared to others.
Conclusion: Improvements in the nutrition and QOL are visible even in the initial short-term follow-up and these are important parameters in global assessment for health and well-being in HIV/AIDS.
Keywords: Anthropometry, antiretroviral therapy, nutrition, quality of life
|How to cite this article:|
Sharma A, Gupta M, Kaur J, Lehl SS. Short term impact of antiretroviral therapy (ART) on nutritional status and quality of life (QOL) of retropositive patients. J NTR Univ Health Sci 2022;11:323-7
|How to cite this URL:|
Sharma A, Gupta M, Kaur J, Lehl SS. Short term impact of antiretroviral therapy (ART) on nutritional status and quality of life (QOL) of retropositive patients. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Apr 1];11:323-7. Available from: https://www.jdrntruhs.org/text.asp?2022/11/4/323/371758
| Introduction|| |
Human immunodeficiency virus (HIV) infection has a great impact worldwide with globally, 37.7 million [30.2–45.1] people living with HIV in 2020. Data regarding anthropometric, nutritional assessment and quality of life (QOL) are lacking in these patients. To address these gaps, a prospective study to understand the impact of antiretroviral therapy (ART) initiation on improvement in these parameters among HIV-infected individuals was conducted. We hypothesized that post-ART, the overall well-being and nutritional status will improve. The study aimed to determine the short-term impact of ART on QOL and nutritional status of retropositive patients receiving ART.
| Material and Methods|| |
The study was conducted in the Department of General Medicine, Functionally Integrated Anti-retroviral Therapy (FIART) outpatient area after due clearance from the Research and Ethics Committee of the institute. ART naive (receiving ART for the first time) with a body mass index (BMI) <19.5 were included in the study. Patients were excluded if they were pregnant, lactating, <18 years of age, were referred to other health care centers, did not follow-up, had received ART before, had co-infections like tuberculosis or those who suffered from terminal illnesses. A total of 60 patients fulfilling the inclusion criteria were enrolled in the study after explaining the purpose of the study and obtaining their informed consent. The confidentiality of the patients was ensured. Data collection, detailed nutritional, anthropometric assessment, QOL assessment were carried out with the help of WHO QOL brief questionnaire. The nutritional assessment and QOL assessment was carried twice; once at the start of ART and then after 3 months of follow-up. All categorical variables were compared using Chi-square and Fisher's exact test and continuous variables using Student's t-test. Data are expressed as mean (±SD, standard deviation). For statistical analysis, P < 0.05 was considered statistically significant. Statistical analysis was done using the latest Statistical Package for the Social Sciences (SPSS) Version 22.0.
| Observations and Results|| |
The mean age of the participants was 31.2 ± 8.98 years. 46 (76.67%) patients were male and 14 (23.33%) patients were female. 28 (46.6%) patients belonged to the lower middle class (modified Kuppuswamy scale), followed by 14 (23.3%) who belonged to the upper middle class, and 10 (16.6%) belonged to the upper lower class. Of these, 50 (83.3%) patients were married, while the rest were unmarried. 30 (50%) patients had only primary-level of education. The most common route of infection was found to be heterosexual (83.33%), followed by parenteral (13.33%), and homosexuality (3.33%). [Table 1] shows the clinical and biochemical assessments at baseline.
|Table 1: Clinical Features and Biochemical Investigations of the Population at Baseline|
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In our study, the calorie assessment was done based on 24-h dietary recall method. The calorie intake increased in both male (pre-ART calorie intake was 980 kCal, while post-ART calorie intake was 1175 kCal) and female (pre-ART calorie intake was 865 kCal, while post-ART calorie intake was 1024 kCal). The overall improvement was also noticeable (pre-ART calorie intake was 922 kCal, while post-ART calorie intake was 1098 kCal). Although the calorie intake was subjective and varied from patient-to-patient, the mean calorie intake was found to be increased.
A slight increase in all the anthropometric values namely, BMI, mid-arm circumference, triceps, subscapular and suprailiac skinfold thickness, and waist–hip ratio was observed. The percentage of patients having temporal hollowing decreased after intervention with ART [Table 2] and [Figure 1].
|Table 2: Comparison of Anthropometric Measurements and QOL Domains before and After Art|
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|Figure 1: Graphical representation of anthropometric measurements before and after ART|
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The QOL was observed by comparing six domains: physical, psychological, level of independence, social relations, environment, and personal beliefs both before and after initiation of ART [Table 2]. The QOL increased marginally in all domains post intervention with ART. The maximum increase was seen in the domain of personal beliefs, while the minimum improvement was seen in the domain of social relations as can be seen in [Figure 2].
|Figure 2: Overall comparison in the different domains of QOL before and after ART|
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| Discussion|| |
HIV infection remains one of the most dreaded diseases in the history of mankind. The global prevalence of HIV is 0.7% among adult population with 28.2 million people accessing ART in June 2021. With the availability of antiretroviral drugs in 1987 and later combination ART in 1996, the mortality burden and progression to AIDS has declined by 60–80%. In 2016, WHO recommended TLE treatment, that is, tenofovir (TDF) in combination with lamivudine (3TC) and efavirenz (EFV), or TDF with emtricitabine (FTC) and EFV, preferentially as fixed dose combination; but in 2018 Dolutegravir and Raltegravir has been approved as first-line therapy for ART. These regimens are associated with lesser adverse effects and better virological response as compared to previous regimens. In patients receiving the Dolutegravir along with Tenofovir alafenamide or emtricitabine combination was shown to have the greatest weight gain. Laboratory measurements, such as CD4 cell count and plasma HIV RNA levels, not only helps in determining the stage of infection but also serves as prognostic markers. The goal to reduce the morbidity and mortality is best accomplished by using effective ART to maximally inhibit HIV replication to sustain the viral load below acceptable limits.
Most of the people living with HIV/AIDS (PLHIV) complain of fatigue leading to difficulty in carrying out their daily activities and living an active social life. QOL assessment can help evaluate accurately how their lives are affected by the disease. WHO defines QOL as individual's perception of their position in life in the context of culture and value systems, and in relation to their goals, expectations, standards, and concerns. ART is capable of improving patients survival, reducing the risk of HIV-related opportunistic infections, and improving their survival and QOL. QOL is currently considered essential in HIV infection, as commonly used end-points (CD4 level, viral load, and opportunistic diseases) are inadequate to catch the complexity of treatment outcomes.
Nutritional support should be fundamental to a comprehensive response to HIV/AIDS as poor nutritional status is associated with morbidity, and reduced survival, even when ART is available. Good nutritional status in these patients plays an important role in enhancing the immune system and cope up with the opportunistic infections. Studies from resource poor settings have shown that their lack of access to the nutritious foods leads to a great impact on the success of ART. However, most studies indicate that an early initiation of ART prior to development of severe malnutrition and decline in functional status may be more beneficial in nutritional and immunological parameters. In our study the nutritional assessment showed subsequent improvement after initiation of therapy. Fatigue, lack of appetite, social aspect such as anxiety leading to anorexia can contribute to the low pre-ARTcaloric intake in these patients. BMI is an important predictor of mortality in HIV. A slight increase in the overall mean BMI was observed in our study, which could be an indicator for better nutrition.
The anthropometric measurements and QOL were also compared within different groups – namely gender, education, and socioeconomic classes. The incidence was skewed in the direction of males with females comprising a small fraction of the sample population which could be attributed to the increased stigma associated with females or due to a hospital seeking behavior in males. The temporal hollowing decreased in most patients with higher decrease linked to males, higher education and higher socioeconomic strata. The patients employed in skilled/permanent job had a better improvement.
Our study brought to light the immense importance of antiretroviral therapy from a social and psychological point of view as well. The QOL of lower socioeconomic standard showed a lesser increase as compared to others which could be due to lack of proper social support, poor nutrition, increased workload, and various myths associated by HIV due to poor information percolation. There was no discernible evidence linking the marital status and being retropositive. Education also played a more important role as those who received secondary or higher education showed more improvement in their QOL. This is probably due to safer sexual practices, as validated by other studies. The incidence of HIV is more in the underdeveloped and developing nations where the literacy rate is low. Detailed understanding of the underlying mode of transmission of the disease can help in reducing the social stigma faced by the infected person. Hence, education is one of the most important step in reducing the incidence of HIV.
Almost all the patients reported an improvement in their overall well-being, it also reduced their stress levels as deciphered from their interviews, as proper information and ART intervention helped them to come to terms with the disease. Amongst the six domains which help to understand the condition of the patient, the improvement in personal beliefs was found to be maximum while a marginal increase was seen in all the domains. This could be attributed to higher self-esteem in the patient or a general feeling of well-being due to improved nutrition. Hence, all these spheres are knit closely together and each of these factors has an effect on the other.
| Conclusion|| |
Our study has attempted to look at the social perspective of the PLHIV by looking at their QOL improvement and their physical well-being in the form of improved nutritional parameters. Although, the data in this pilot study has not reached the level of statistical significance, the study needs to be conducted at a higher level as there is a promising trend toward improvement in the aspects highlighted above. This may help the treating physicians to understand the social and the nutritional impact of the current antiretroviral regimens.
Declaration of patient consent
The authors certify that they have obtained appropriate patient consent for inclusion in the study. The patient(s) has/have given his/her/their consent for clinical information to be reported in the journal.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]