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The body mass index (BMI) may contribute somewhat to drug metabolism, thus affecting the efficacy of antiretroviral therapy (ART). CD4+ counts in people infected with HIV are essential in determining the stage of the disease, initiation of antiretroviral therapy, opportunistic infections and evaluating treatment outcomes. The aim of this study was to determine the association of BMI and clinical stage with CD4+ counts in HIV patients seeking treatment using first-line antiretroviral therapy (ART).
An analytic study with a cross-sectional approach was conducted involving 251 HIV/AIDS patients who had received first-line antiretrovirals over six months. BMI, clinical staging according to WHO and CD4 + were collected. Multiple linear regression was used to evaluate the relationship between BMI, clinical stage and CD4+.
Among the enrolled patients, the median age was 36 years, 135 (55%) of the patients was female, 102 (40.6%) was overweight/obese, 161 (64.1%) was in stage 3 of the disease, and the median CD4+ count was 389 cells/mm3. Multiple linear regression test showed two variables with a significant effect on CD4+ count, namely BMI (B=69.247; 95 % CI : 42.886-95.608) and clinical stage (B=61.590; 28.910-94.270). BMI was the most influencing factor for CD4+ count (β=0.307) compared to clinical stage (β=0.216).
Body mass index was the most influencing factor for CD4 + counts of HIV/AIDS patients. Regular ART can increase CD4+ counts and maintain the health of HIV/AIDS patients.
World Health Organization. HIV/AIDS: key facts. Geneva: World Health Organization;2020.
Kementrian Kesehatan RI. General situation of HIV/AIDS and HIV test. Jakarta: Pusat Data dan Informasi Kementrian Kesehatan RI; 2018.
Dinas Kesehatan Provinsi Papua Barat. Jumlah kasus HIV AIDS Papua Barat; 2016.
Weinberg JL, Kovarik CL. The WHO Clinical Staging System for HIV/AIDS. Virtual Mentor 2010;12:202-6. DOI: 10.1001/virtualmentor.2010.12.3.cprl1-1003.
Tsegaye AT, Wubshet M, Awoke T, Alene KA. Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study. BMJ Open 2016;6:e012537. doi: 10.1136/bmjopen-2016-012537.
Seyoum A, Ndlovu P, Zewotir T. Quasi-Poisson versus negative binomial regression models in identifying factors affecting initial CD4 cell count change due to antiretroviral therapy administered to HIV-positive adults in North-West Ethiopia (Amhara region). AIDS Res Ther 2016;13:36. doi: 10.1186/s12981-016-0119-6.
Dalhatu I, Onotu D, Odafe S, et al. Outcomes of Nigeria’s HIV/AIDS treatment program for patients initiated on antiretroviral treatment between 2004-2012. PLoS One 2016;11:e0165528. doi: 10.1371/journal.pone.0165528.
Koethe JR, Jenkins CA, Lau B, et al. Body mass index and early CD4+ T cell revovery among adults initiating antiretroviral therapy in North America,1998-2010. HIV Med 2015;16:572–7. doi: 10.1111/hiv.12259.
Chakravarty J, Sundar S, Chourasia A, et al. Outcome of patients on second line antiretroviral therapy under programmatic condition in India. BMC Infect Dis 2015;15:517. doi: 10.1186/s12879-015-1270-8.
Thao VP, Quang VM, Wolbers M, et al. Second-line HIV therapy outcomes and determinants of mortality at the largest HIV referral center in Southern Vietnam. Medicne (Baltimore) 2015;94:e1715. doi: 10.1097/MD.0000000000001715.
Swain PK, Grover G. Determination of predictors associated with HIV/AIDS patients on ART using accelerated failure time model for interval censored survival aata. Am J Biostat 2016;6:12–9. DOI: 10.3844/ajbssp.2016.
Asiimwe SB, Kanyesigye M, Bwana B, Okello S, Muyindike W. Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa. BMC Infect Dis 2016;16:43. doi: 10.1186/s12879-016-1392-7.
in ‘t Veld DH, Balestre E, Buyze J, et al. Determinants of weight evolution among HIV-positive patients initiating antiretroviral treatment in low resource settings. J Acquir Immune Defic Syndr 2015;70:146–54. doi: 10.1097/QAI.0000000000000691.
Baraki AG,Gezie LD, Zeleke EG, Awoke T, Tsegaye AT . Body mass index variation over time and associated factors among HIV-positive adults on second-line ART in northwest Ethiopia: a retrospective follow-up study. BMJ Open 2019;9:e033393. doi:10.1136/bmjopen-2019-033393.
Tang AM, Sheehan HB, Jordan MR, et al. Predictors of weight change in male HIV-positive injection drug users initiating antiretroviral therapy in Hanoi, Vietnam. AIDS Res Treat 2011;2011:890308. doi: 10.1155/2011/890308.
Li N, Spiegelman D, Drain P, et al. Predictors of weight loss after HAART initiation among HIV-infected adults in Tanzania. AIDS 2012 ;26:577–85. doi: 10.1097/QAD.0b013e32834f9851.
World Health Organization Regional Office for Europe. Body mass index - BMI. Copenhagen, Denmark: World Health Organization Regional Office for Europe;2020.
Koethe JR, Jenkins CA, Lau B, et al. Higher time-updated body mass index: association with improved CD4+ cell recovery on HIV treatment. J Acquir Immune Defic Syndr 2016;73:197–204. doi: 10.1097/QAI.0000000000001035.
Crum-Cianflone NF, Roediger M, Eberly LE, et al. Impact of weight on immune cell counts among HIV-infected persons. Clin Vaccine Immunol 2011;18:940–6. doi:10.1128/CVI.00020-11.
Tedaldi EM, Brooks JT, Weidle PJ, et al. Increased body mass index does not alter response to initial highly active antiretroviral therapy in HIV-1-infected patients. J Acquir Immune Defic Syndr 2006;43:35–41. doi: 10.1097/01.qai.0000234084.11291.d4.
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treatning and preventing HIV infection : recommendation for a public health approach. 2nd.ed. Geneva: World Health Organization;2016.
Widiyanti M, Hadi MI, Adiningsih S, et al. Demographic characteristics of the people living with HIV in Papua. J Heal Sci Prev 2019;3:10–5. DOI: http://doi.org/10.29080/jhsp.v3i1.175.
Widiyanti M, Ubra R, Fitriana E. Low body mass index increases risk of anemia in patients with HIV-AIDS receiving antiretroviral therapy. Univ Med 2017;36:221–7. DOI 10.18051/UnivMed.2017.v36.221-227.
de Araújo Mariz C, de Albuquerque MFPM, de Alencar Ximenes RA, et al. Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity. Cad Saude Publica 2011;27:1997–2008. doi: 10.1590/s0102-311x2011001000013.
Lake JE, Currier JS. Metabolic disease in HIV infection. Lancet Infect Dis 2013;13:964–75. doi: 10.1016/S1473-3099(13)70271-8.
Duncan AD, Goff LM, Peters BS. Type 2 diabetes prevalence and its risk factors in HIV: A cross-sectional study. PLoS ONE 2018; 13:e0194199. doi: 10.1371/journal.pone.0194199
Crum-Cianflone N, Roediger MP, Eberly L, et al. Increasing rates of obesity among HIV-infected persons during the HIV epidemic. PLoS ONE 2010;5:e10106. doi: 10.1371/journal.pone.0010106.
Thimmapuram R, Lanka S, Esswein A, Dall L. Correlation of nutrition with immune status in human immunodeficiency virus outpatients. Mo Med 2019;116:336–9.
Sicotte M, Langlois ÉV, Aho J, Ziegler D, Zunzunegui MV. Association between nutritional status and the immune response in HIV + patients under HAART: protocol for a systematic review. Systematic Reviews 2014 3:9. doi: 10.1186/2046-4053-3-9.