EFFECTS OF ANTIRETROVIRAL DRUGS ON NUTRITIONAL STATUS OF ADULT WHO HAVE BEEN ON DRUGS FOR 6-10 WEEKS AGED 18-50 YEARS

CASE STUDY: BWEYOGERERE HEALTH III

LIST OF ACRONYMS AND ABBREVIATION

AIDS                          Acquired Immunodeficiency Syndrome

ART                            Antiretroviral Therapy

ARV                           Antiretroviral

ATZ                            Zidovudine

BCM                           Body Cell Mass

BF                               Body Fat

CD4                            Cluster Designation four

CDC                           Centre for Disease Control and Prevention

DEXA                        Dual energy x-ray absorbometry

D4T                             Stavudine

EFV                            Efaviranz

FANTA                      Food and Nutrition Technical Assistance

FAO                            Food and Agricultural Organization

FM                              Fat Mass

HAART                      Highly Active Antiretroviral Therapy

HIV                             Human Immunodeficiency Virus

LBM                           Lean Body Mass

MOH                          Ministry of Health

MUAC                        Mid-upper Arm Circumference

NGO                           Non-governmental organization

NNRTIs                      Non Nucleolus Reverse Transcriptase Inhibitors

NRTIs                         Nucleolus Reverse Transcriptase Inhibitors

NVP                            Nevarapine

PEPFAR                    President’s Emergency Plan For AIDS Relief

PLHIV                       People living with HIV

PI                                Protease Inhibitors

SPSS                           Statistical Package for Social Sciences

TASO                         The AIDS Support Organization

UBOS                         Uganda Bureau of Statistics

UDHS                         Uganda Demographic and Health Survey

UHSBS                       Uganda HIV/AIDS Sero-Behavioural Survey

UNAIDS                    The Joint United Nations Programme on HIV/AIDS

UNWFP                     United Nations World Food Program

USAID                        United States Agency for International Development

UNSSCN                    United Nations system standing committee on Nutrition

WHO                          World Health Organization

3TC                             Lamivudine

ABSTRACT

The topic of the study is the effects of antiretroviral drugs on nutritional status of adult who have been on drugs for 6-10 weeks aged 18-50 years

This study was conducted at Bweyogerere health Centre iii and the purpose is toassess the effects of nutritional status of adults who have been on drugs for 6-10 weeks aged 18-50 years at Bweyogerere health Centre iii

The research objectives are to; effects of specific ARVs drugs on nutritional status of client for the period of 6-10 weeks, the relationship between dietary partners and ARVs on the nutritional status of the clients and the variation in anthropometric indices during the duration of 6-10 weeks on ARVS.

The study used both qualitative and quantitative techniques of data analysis, The researcher will use the above methods because many aspects will be covered in the study, Qualitative research method will be used because it collects information within a short time while quantitative will be through interview to cross check what has been given.

The study recommends that there is a need to introduce programs like physical exercise, nutrition education and counseling aiming at improving lean body mass and reduction of unnecessary body fat gain as well as abdominal obesity for the subjects who gain more body fat but less or not lean body mass.

All HIV patients who are starting HAART at Bweyogere health III should be advised on dietary management of nutrition related side effects in order to reduce problems that are common in the first few weeks of ARV treatment.

CHAPTER ONE

1.0 INTRODUCTION

This chapter presents the Background, problem statement, purpose, general objectives, specific objectives, research questions, Significance of the study, and scope of the study.

1.1 Back ground

The last two decades, HIV/AIDS has continued to spread across all continents causing the death of millions of adults in their prime age, disrupting and impoverishing families and turning millions of children into orphans, (UNAIDS, 2009).

HIV/AIDS affects the most productive segments of the populations, and the epidemic has thus tremendously reduced workforces and reversed many years of economic and social progress and has in some cases posed threat to political stability.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS, 2009), there were about 39.5 million people living with HIV by the end of 2006. Out of these, 37.2 million were adults and 2.3 million were children below the age of 15 years. There were 4.3 million new infections in 2006. In Sub-Saharan Africa about 2.8 million people were infected with HIV and 24.7 million people were living with HIV. Despite recent improved access to antiretroviral treatment (ART) and care in many of the world’s regions, the epidemic claimed 2.9 million lives in 2006.

Although efforts have beenput in place to fight HIV/AIDS in Uganda, about 1million people are leaving withHIV/AIDS (MOH and ORC Macro, 2006). According to Uganda HIV/AIDS serobehaviouralsurvey (2004-2005), the prevalence of HIV among adults (18-59 years ofage) was 6.7 % and the prevalence is higher in Kampala district about 8.5 % thanother districts. The high prevalence of HIV/AIDS in this most productive age hasgreat impact on health, economic and social aspects.

The advent of potent Anti-Retroviral Treatment (ART) in 1996 led to a revolution in thecare of patients with AIDS in the developed world.

Although this treatment is notcurative and also presents new challenges with respect to side effects and drug resistance,it has dramatically reduced rates of morbidity and mortality, have improved the qualityof life of people with HIV/AIDS and have revitalized communities (3) Moreover,HIV/AIDS is now perceived as a manageable chronic illness rather than as a plague.Unfortunately, most of the 39.5 million people currently living with HIV/AIDS reside indeveloping countries and do not share this improvement in prognosis, (UNAIDS, 2009).

Studies conducted before the widespread use of ART showed that wasting wasassociated with diminished survival rate (Kotleret al., 1989).

Analysis of a morecontemporary cohort of patients, many of whom were taking highly activeantiretroviral therapy (HAART) showed that wasting still occurs and remains animportant predictor of death (Wankeet al., 2002).

Most of body composition studies have been done in developed countries and it wasfound out there were changes in body composition among HIV positive individuals onHAART or and those not on HAART (Ottet al., 1993; Yelmokaset al., 2001;Shikumaet al., 2004).

Although there are data available from developed countriesindicating that HAART may result in changes in body composition, these changesalong with dietary pattern of HIV positive individuals initiating HAART are lackingin resource limited settings (Schwenk, 1999; Wanke, 2002).

Good nutrition along with continued monitoring of body composition changes andantiretroviral treatment are therefore vital for the well being of PLHIV. Basing on this background this study therefore intends to investigate into the effect of antiretroviral drugs on nutritional status of adult aged 18-50 years, with specific reference to Bweyogerere health III.

1.2 Problem Statement

The high increase in the availability of antiretroviral drugs among adults aged 18-50 years has a great impact on the nutritional status of people living with HIV/AIDS (PLHIV), (MOH and ORC Macro, 2006).

HIV infection increases energy requirements and affects nutrition through increasing energy expenditure, reductions in food intake, nutrient malabsorption and loss andcomplex metabolic alterations (Macallan, 1995; Babamento and Kotler, 1997).

The inadequate dietary intake among PLHIV to meet the increased demand for both energy and protein associated with HIV infection result in weight loss (Piwoz and Preble, 2000).

Hogg et al. (1998) and Castlemanet al. (2004) noted the role of antiretroviral therapy in the management of HIV and contribution to improved nutritional status; however, they mentioned that ART could create additional needs and dietary constraints which can contribute to weight change.

Despite of the fact that there has been a considerable rise in the number of people having access to Antiretroviral drugs among adults aged 18-50 years, most of PLHIV have been found to posses poor nutritional habits coupled with poor appetite, basing on this the study therefore intends to investigate in to the effects of antiretroviral drugs on nutritional status of adult aged 18-50 years at Bweyogerere Health III.

1.3 Objective of the Study

1.3.1 General objective

The study intended to assess the effects of nutritional status of adult who have been on drugs for 6-10 weeks aged 18-50 years at Bweyogerere Health III.

1.3.2 Specific Objectives

1. To establish the effect of specific ARVs drugs on nutritional status of client for the period of 6-10 weeks.
2. To establish the relationship between dietary partners and ARVs on the nutritional status of the clients.

• To determine the variation in anthropometric indices during the duration of 6-10 weeks on ARVS.

1.4 Research Questions

1. What are the effects of specific ARVs drugs on nutritional status of client for the period of 6-10 weeks?
2. What is the relationship between dietary partners and ARVs on the nutritional status of the clients?

• What are the variations in anthropometric indices during the duration of 6-10 weeks on ARVS?
  • Hypothesis

ARV drugs have an effect on nutritional status of client with in a period of 6-10 weeks.

There is no observable relationship between ARV drugs and nutritional status of the clients with a period of 6-10 weeks.

• Conceptual Frame Work

Antiretroviral drugs                         Nutritional status

The conceptual frame work demonstrated that the antiretroviral drugs and nutritional status have an effect on the CD4 count of the HIV positive people.

1.5 Scope of the study

The study scope covered the following aspects;

1.6.1 Study scope

The study scope covered, the effects of specific ARVs drugs on nutritional status of

client for the period of 6-10 weeks, the relationship between dietary partners and ARVs on the nutritional status of the clients and  the variations in anthropometric indices during the duration of 6-10 weeks on ARVS.

1.6.2 Geographical scope

The study was carried out at Bweyogerere health III.

1.6.3 Time scope

The period of data to be considered in the organization was from 2012-2015 and period of body of knowledge in reviewing literature was from 2000-2015.

1.7. Significance of the study

The will assist future researchers with information regarding the dietary patterns and nutrition related life styles of HIV positive adults aged 18-50 years during the first 6 and 10 weeks of ARV treatment.

The study will also enable future researchers with information regarding the nutritional related side effects arising from taking of antiretroviral Drugs.

The study will also enable the academicians with knowledge regarding nutrition status of adults aged 18-50 years.

Nutritional related side effects arising from taking of antiretroviral

1.8 justifications of the study

Due to the fact there is a global rise in the number of HIV/AIDS positive patients on antiretroviral drugs there is a need to carry out research on nutritional status of adult aged 18-50 years.