RESUMO
Background: Metabolic and nutritional abnormalities among people living with human immunodeficiency virus (PLHIV) have been reported due to either their HIV infection, primary malnutrition caused by insufficient intake or consequences of the ART regimen provided. This study investigated the prevalence and patterns of nutritional abnormalities including morphological changes among HIV patients under combination Antiretroviral Therapy (cART) in the Bia-West District of the Western North Region. Methods: We employed a hospital-based retrospective longitudinal design. Records of 180 patients with HIV infection before and after antiretroviral therapy (ART) initiation were extracted at the Essam Government Hospital. Eligibility criteria included being on treatment without change in regimen for at least one year and without defaulting in scheduled visits. Data extracted included patients' demography, nutritional parameters and medication history. We assessed patients' nutritional characteristics with the subjective global assessment (SGA) tool which includes five components of medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity & metabolic stress) and two components of physical examination (signs of fat loss and muscle wasting, alterations in fluid balance). Results: Malnutrition, lipodystrophy and body wasting among HIV patients were 48.3% (36.5-62.4), 43.9% (32.6-57.7) and 33.3% (23.6-46.0) respectively. Incremental percentage trends of malnutrition (stage I- 7.4%, stage II -22.4%, stage III-24.7%) and lipodystrophy (Stage I - 22.2%, Stage II - 48.7%, Stage III - 51.9%) were significantly associated with worsening disease status. Patients on AZT+3TC + NVP combined regimen presented with the highest malnutrition [52.9% (28.5-76.1)], lipodystrophy [64.7% (38.6-84.7)] and loss of muscle mass [47.1% (23.9-71.5)]. Long-term ART use was significantly associated with high malnutrition rate (p= 0.02620) and increasing muscle mass loss (p = 0.0040). Conclusion: High malnutrition, lipodystrophy and muscle wasting exist in PLHIV on cART in the Bia-West District. These adverse nutritional effects may be modulated by disease severity, ARV medication and duration.
RESUMO
Treponemal infections can be blood-borne with great public health consequences. This study is aimed at comparatively describing the five-year (2013-2017) regional epidemiology of treponemal infection using pregnant women in the sentinel survey and apparently healthy blood donors as a proxy for the general population at four sentinel sites in the Volta and Oti Regions of Ghana. We analyzed retrospective data from 17,744 prospective blood donors aged 18 to 58 years and 7,817 pregnant women in a sentinel survey with ages from 15 to 49 years at Hohoe, Ho, Tongu, and Krachi West sentinel sites in the Volta and Oti Regions. Laboratory data extracted include variables such as age, gender, date of blood donation, and Treponema pallidum chromatographic immunoassay results from the blood banks of the four study sites. The five-year treponemal infection rate among the pregnant women in the sentinel survey and prospective blood donors was 0.79% and 2.38%, respectively. Site-specific infection rate for population-based/sentinel survey was 4.6%/1.1%, 2.0%/0.5%, 1.3%/1.1, and 1.2%/0.3% for Hohoe, Ho, Krachi West, and Tongu, respectively. Significant gender disparity in Treponemal infection rate exists with a male preponderance. The regional infection rate in the sentinel survey is lower compared to the general population. Therefore, the use of pregnant women as a proxy for population estimates could underestimate the burden in the study jurisdiction.