Quality of Life and Nutritional Status of People Living with HIV/AIDS (PLHA’s) in Western Maharashtra-A Prospective Cohort Study

Abstract

Introduction: Decades ago HIV/AIDS epidemic was considered as unprecedented human catastrophe. With Anti-Retroviral Therapy (ART) services easily available and accessible to everyone, HIV/AIDS has become a chronically manageable illness wherein Nutritional status and Quality of Life (QOL) play a key role in long-term impact of ART on People Living with HIV/ AIDs (PLHA’s). Therefore, a study is needed to better understand the factors affecting them. Aim: To assess the psychological component of QOL of PLHAs and their association with nutritional status, health satisfaction and socioeconomic factors at the end of one year and to recommend measures to improve the QOL based upon the findings of the study. Materials and Methods: A prospective cohort study was carried out across two ART centres in western Maharashtra. PLHAs who were lately placed on ART and consented to participate were included in the study and followed up for one year. A total of 10 PLHAs were lost to follow-up and finally 249 were included in the analysis. Data were collected by means of prevalidated, pre-tested questionnaire with relevant investigations and anthropometric measurements. Results: With respect to nutritional status, 107 (43%) were having under-nutrition at the baseline and 84 (33.7%) at the end of one year in spite of free ART. Anaemia was found among 179 (71.9%) participants at baseline and 159 (63.9%) at the end of one year. Low albumin was seen among 39 (15.7%) participants at the baseline and similar number of them were at the end of one year. Dietary intake was inadequate among 178 (71.5%) participants. Forty (16.1%) participants had excellent QOL, 82 (32.9%) still had poor QOL in spite of free ART being given for one year. There was no significant difference in the health status before and after one year of ART among 180 (72.3%) participants. Female sex deteriorated income status, deteriorated BMI status, deteriorated anaemic status, deteriorated CD4 count, after health status less than five, diet inadequacy were significantly associated with poor QOL. On multiple logistic regression model, female sex was 2.4 times (p=0.014) and deteriorated BMI/undernutrition was 3.6 times (p<0.001) more associated with poor QOL and were statistically significant. Conclusion: Immediate measures need to be directed to improve nutritional status in PLHA’s by giving nutritional support (food security), job security, income security along with free ART in order to have excellent QOL as compared to providing free ART alone.

Keywords

• anti-retroviral therapy
• food security
• job security
• malnutrition