ASSESSMENT OF DIETARY PATTERN AND NUTRITIONAL STATUS OF PEOPLE LIVING WITH HIV/AIDS ATTENDING SOME VOLUNTARY AND COUNSELLING TEST (VCT) UNITS

ABSTRACT

This study assessed the dietary pattern and nutritional status of People Living with HIV/AIDS (PLWHA) attending some voluntary and counseling test units in Kaduna metropolis.The studied subjects consisted of 74 adult patients infected with HIV between the ages of 18 and 60 years and 74 age-and-sexed-matched apparently healthy volunteers who were HIV negative as control group.A semi-structured questionnaire was used to collect information on the socio-economic and demographic characteristics of the subjects. Dietary diversity of the subjectsand control were assessed using food frequency questionnaire. Blood serum total protein, total cholesterol, HDL and LDL cholesterol were determined spectrophotometrically while serum zinc and iron were measured using Atomic Absorption Spectrophotometer. Result obtained shows that majority of patients (39.19%) were between 26 and 33years. A sizeable percentages of patients (33.78%) and control (52.7%) were overweight (BMI ≥ 25.00kg/m²), while some patients (25.68%) and control (37.93%) were under weight (BMI < 18.49kg/m²). A significantly (P<0.05) higher total protein was observed in patients compared to the control while significantly (P<0.05) lower levels of LDL-cholesterol and CD₄ counts were recorded in HIV patients compared to the control. There was also significantly (P<0.05) lower levels of zinc and iron in HIV patients compared to the control. Good dietary diversity was observed in the HIV patients as their dietary pattern showed regular intake of energy and other food groups which may explain why more patients had good BMI contrary to the usually observed incidence of weight loss and wasting among PLWHIV. They also showed normal level of total cholesterol and HDL which implies low risk of atherosclerosis with just little proportion at risk as a result of high LDL levels. Normal zinc levels in the PLWHIV may explain the normal weight observed contrary to what is observed in HIV patients with frequent diarrhea as zinc is effective in the reduction of the incidence, severity and duration of diarrhea. The PLWHIV should be encouraged to maintain dietary diversification with adequate consumption of four or all the food groups.Also, attention should be given to other causes of death in PLWHA such as cardiovascular diseases and overweight.

TABLE OF CONTENTS

Title Page

Abstract

Table of Contents

List of Abbreviations

CHAPTER ONE

INTRODUCTION

1.1       Statement of Research Problem

1.2       Justification

1.3       Aim and Objectives

1.3.1    Aim

1.3.2    Specific Objectives

CHAPTER TWO

2.0       LITERATURE REVIEW

2.1       HIV Prevalence

2.2       Nutritional Status

2.3       Assessment of Nutritional Status

2.3.1    Clinical nutritional assessment

2.3.2    Anthropometric nutritional assessment

2.3.3    Dietary nutritional assessment

2.3.4    Biochemical nutritional assessment

2.4       Socio-economic Characteristics

2.4.1    Trend in HIV/AIDS prevalence in Nigeria

2.5       HIV/AIDS and Nutrirtion

2.6       Biochemical Parameters

2.6.1    CD4 T-cells

2.6.1    Cholesterol

2.6.1    HDL-Cholesterol

2.6.1    LDL-Cholesterol

2.7       Body Mass Index (BMI)

2.8       Dietary Patterns

2.9.1    Food Diversity in Management of HIV/AIDS

2.9.1.1 Energy Giving Foods

2.9.1.2 Body Building Foods

2.9.1.3 Protective Foods

2.9.2    Meal Frequency

2.9.2.1 Nutrient Requirement of People Living With HIV/AIDS

2.9.2.2 Macronutrient Requirement of People Living With HIV/AIDS

2.9.2..3 Micronutrient Requirement of People Living With HIV/AIDS

CHAPTER THREE

3.0       MATERIALS and METHODS

3.1       Materials

3.1.1    Study Area

3.1.2    Study Design

3.1.3    Study Population

3.1.4    Inclusion Criteria

3.1.5    Exclusion Criteria

3.1.6    Informed Consent

3.1.7    Ethical Approval

3.1.8    Sample Size Determination

3.1.9    Sampling

3.1.10 Sampling Technique

3.1.11 Chemicals

3.1.12 Equipment

3.2       Methods

3.2.1    Blood Sample Collection

3.2.2 Characteristics of Study Population

3.2.3 Measurement of Biochemical Parameters

3.2.4 Serum Total Protein

3.2.5 Serum Albumin

3.2.6 Serum Cholesterol

3.2.7 Serum HDL-Cholesterol

3.2.8 Serum Triglycerides

3.2.9 Serum LDL-Cholesterol

3.2.10 Serum Zinc

3.2.11 Serum Iron

3.2.12 CD4 Count

3.2.13 Measurement of Anthropometric Characteristics

3.2.14 Measurement of Atherogenic Index

3.2.15 Assessment of Dietary Pattern

3.3       Statistical Analysis

CHAPTER FOUR

4.0       RESULTS

4.1       Demographic and Socio-Economic Characteristics of People Living With HIV/AIDS Attending VCT Units in Kaduna Metropolis

4.2       Anthropometric Characteristics of People Living With HIV/AIIDS Attending VCT Units in Kaduna Metropolis

4.3       Biochemical Parameters of People Living With HIV/AIDS Attending VCT Units in Kaduna Metropolis

4.4       Lipid Profile of People Living With HIV/AIDS Attending VCT Units In Kaduna Metropolis

4.5       CD4+ Countof People Living With HIV/AIDS Attending VCT Units in Kaduna Metropolis

4.6       Zinc and Iron Concentrationof People Living With HIV/AIDS Attending VCT Units in Kaduna Metropolis

4.7       Correlation CD4+ Counts With the Concentration of Zinc and Iron of People Living With HIV/AIDS Attending VCT Units In Kaduna Metropolis

4.8       Frequency of Food Consumption  of People Livingwith HIV/AIDS Attending VCT Units in Kaduna Metropoli

CHAPTER FIVE

5.0       DISCUSSION

CHAPTER SIX

6.0       SUMMARY, CONCLUSION AND RECOMMENDATIONS

6.1       Summary

6.2       Conclusions

6.3       Recommendations

REFERENCES

APPENDIX

List of Abbreviations

AIDS                   Acquired Immunodeficiency Syndrome

ART                     Anti Retroviral Therapy

BMI                     Body Mass Index

BIA                      Bioelectrical Impedance Analysis

CDC                    Center for Disease Control

CHOD                Cholesterol Oxidase

CT                         Computed Tomography

CVA                    Cerebro-Vascular Accident

CSWs                  Commercial Sex Workers

DEXA                Dual Energy XrayAbsortiometry

FANTA               Food And Nutrition Technical Assistance

FFQ                      Food Frequency Questionnaire

FMOH                Federal Ministry Of Health

GOD                    Glucose Oxidase

GPO                     Glycerol-3-Phosphate Oxidase

HIV                      Human Immuno-Deficiency Virus

HDL                    High Density Lipoprotein

LDL                     Low Density Lipoprotein

VCT                     Voluntary And Counseling Test

MRI                     Magnetic Resonance Imaging

NIH                      National Institute of Health

PAP                      Phenol Amino Phenazone

SSA                      Sub Saharan Africa

STDs                    Sexually Transmitted Diseases

PLWHA            People Living With HIV and AIDS

WHO                   World Health Organization

VLDL                 Very Low Density Lipoprotein

UNDP                  United Nation Development Programme

CHAPTER ONE

INTRODUCTION

Acquired Immune Deficiency Syndrome, popularly known as AIDS, is caused by the virus, Human Immuno-deficiency Virus (HIV). This is a tiny germ that is invisible to the eye that attacks the immune system of the body. AIDS is a condition in which the virus damages the body immune system and renders it helpless against any infection, (Hawkes et al., 2002). According to the World Health Organization (2005), AIDS is the most dreaded, most feared and the most talked about disease in the world today.It is a deadly disease that has no cure. According to Ojedokun (2004), there are two main sub types: HIV I and HIV II. HIV I is the most common type all over the world while HIV II is only common in West Africa. The intensity and the pattern with which HIV/AIDS affects nutritional status are very much different from that in other infections and in ordinary case of inadequate nutrients intake (Piwoz and Preble, 2000). Due to lack of cure for HIV/AIDS, the immune system of infected patients is under constant exposure to infections which adversely affect the nutritional status and immune competence of the subjects in question (Piwoz and Preble, 2000).

Malnutrition is a serious danger for people living with HIV/AIDS. Even at the early stages of HIV infection when no symptoms are apparent, HIV makes demands on the body‘s nutritional status (Walsh et al., 2003),the risk of malnutrition increases significantly during the course of the infection. Good nutrition cannot cure AIDS or prevent HIV infection, but it can help to maintain and improve the nutritional status of a person with HIV/AIDS and delay the progression from HIV to AIDS-related diseases (Piwoz and Preble, 2000). It can therefore improve the quality of life of people living with HIV/AIDS. Nutritional care and support are important from the early stages of the infection to prevent the development of nutritional deficiencies. A healthy and balanced diet will help to maintain body weight and fitness. Eating well helps to maintain and improve the performance of the immune system

– the body‘s protection against infection – and therefore helps a person to stay healthy (Bartlett, 2003). Many of the conditions associated with HIV/AIDS affect food intake, digestion and absorption, while others influence the functions of the body (Bartlett, 2003). Many of the symptoms of these conditions (e.g. diarrhoea, weight loss, mouth and throat sores, nausea or vomiting) are manageable with appropriate nutrition. Goodnutrition will complement and reinforce the effect of any medication taken.

In Kaduna state, there are few data on the micronutrient status,lipid profile, prevalence of underweight and overweight among PLWHA. Hence, there is a need to study their nutritional status.

1.1                        STATEMENT OF PROBLEMS

Although weight loss and wasting remain common in HIV infection, nutrition related problems such as obesity, diabetes, hyperlipideamia and hypertension also increasingly affect people living with HIV (Piwoz and Preble, 2000). A shift in causes of death from acute opportunistic infections to other causes such as cardiovascular diseases, diabetes and obesity indicates the need for a more comprehensive approach to healthy nutrition for persons infected with HIV (Walsh et al., 2003).

Research has also revealed that micronutrients can modify the course of viral infection and restore the functionality of the immune system (Jariwalla et al., 2011).Studies conducted with both single and multiple nutritional supplements have shown that micronutrients act to control HIV/AIDS by; suppression of virus multiplication and spread, restoration of cell-mediated immune responses and, slowing the rate of progression and reducing the severity of AIDS(Jariwalla et al., 2011).

1.2                        JUSTIFICATION

There are many publications on the epidemiology of the HIV/AIDS and the factors fuelling the epidemic in Nigeria, but there is paucity of data on the nutritionalstatus of people diagnosed with HIV/AIDS.Assessment of nutrition and medical status is crucial to quality nutrition care for every person living with HIV;therefore, there is a need to carry out a comprehensive study on the dietary pattern, biochemical parameters, anthropometric characteristics and micronutrient status for quality nutrition care for persons living with HIV in Kaduna metropolis.

1.3 AIM AND OBJECTIVES

1.3.1                  Aim

To investigate the dietary pattern and nutritional status of People Living with HIV/AIDS (PLWHA) attending voluntary and counseling test (VCT) units of some Hospitals in Kaduna metropolis.

1.3.2                    Specific objectives

The specific objectives of the study are:

i.            To assess the socio-economicand demographic characteristics of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.

ii.             To determine the anthropometric characteristics of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.

iii.             To assess some biochemical parameters of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.

iv.            To correlate the micronutrient status with some biochemical parameters of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.

v.            To determine the dietary pattern of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.