CHAPTER FIVE

DISCUSSION OF RESULTS

This chapter discusses the results presented in chapter four in relation to the literature reviewed in Chapter Two, including the researcher’s views and additional findings.

5.1 Demographic Information

5.1.1 Age of the respondents

The results  in figure 1 in the indicates that most of the respondents in the study are female the study further shows that the female gender dominates the number of patients on ARVS this findings is also in line with MOH and ORC Marco (2006) which indicate the prevalence of HIV being higher among females than males. Similarly, Bukusuba et al. (2007) reported a majority of TASO Jinja beneficiaries were females, this high number of female response rate on females could be due to the fact that females go for HIV testing during their antenatal care and therefore they have high chances of having a high response rate in the study.

5.1.2 Age category of the respondents

The high proportion of study respondents in the age group 30-39 years old could be due to the fact that this age group is sexually active and therefore they have high chances of engaging in un protected sexual intercourse. This finding is also in correspondents with the findings of Macro, (2006) which identified that most of the people in the age group of 35-39 years are sexually active and therefore stand at a high risk of catching the virus.

5.1.3 Educational level of the respondents

This finding further show that HIV prevalence rate is high on people with low educational level, mostly certificate, secondary and primary educational level perhaps this could be because they don’t have information regarding the different ways of preventing the chances of acquiring HIV.

The poor level of education level among the respondents could be a barrier to access of knowledge on HIV prevention methods and awareness. In this study informal business was described as street vending, art, craft, market vending, food vending were among others while the unemployed ones did not have a stable income. This could possibly be due to the effect of HIV/AIDS on health of the patients and leading to absenteeism from job (Bukusuba et al. 2007).

5.1.4 Marital Status

The results in the study indicates that most of the respondents in the study asserted that they were married, this results show that there is high prevalence rate of HIV/AIDS on married people, this findings is also in line with macro, 2006 which asserts that there is high level of HIV infection among the married couple due to the fact they tend to have more than one sexual parterner.

5.1.5 Religion

The findings in the study further shows that most of the Catholics have been encouraged to test for their HIV status and therefore they were able to know about their status and start on ARVS.

5.1.6 Source of food consumed by patients

However the HIV/AIDS pandemic has increased the inability of affected households to put enough food on the table (Bukusuba et al. 2007). The very few subjects who responded that they don’t share food in the household could be due to the reduced productivity and increased medical costs for the PLHIV (Bukusuba et al. 2007).

5.2 Side effects faced by patients after taking drugs

The results in the study indicates that 5% had side effects of Anorexia (loss of appetite), Nausea and vomiting and taste changes while only 2.6% asserted that experienced mouth sores thi findings is also in line with International HIV/AIDS alliance (2007), which asserted that ARVs like Zidovudine, Combivir, Didanosine, Indinavir, and Nelfinavir are responsible for causing Nausea and vomiting, this is also further supported by findings of Meyer, 2003 who asserted that  multiple regimens may have effects such as gastrointestinal upset, diarrhoea, nausea, vomiting, malabsorption and anorexia that negatively affect the patient’s ability to eat adequate.

The results in the study further indicates that 10 (11.4%) of the respondents experienced Nausea and vomiting after taking a combination of Tenofovir+Lamivudine+Efavirenz (TDF+3TC+EFV), while 7 (8.5%) experienced tastes changes, 5 (5.8%) experienced Mouth ulceration (mouth sores) or thrush, 7 (8.5%) experienced abdominal pain, 5 (5.8%) of the respondents faced constipation, 5 (5.8%)  had side effects of Anorexia (loss of appetite) , due to a large percentage of the respondents experiencing Nausal vomiting this results further coincides with Castleman, (2004) who asserts that patients experiencing  nausea and vomiting are also advised to eat small quantities of food and frequently, limit intake of fluids with meals, avoid having an empty stomach, avoid laying down immediately after eating, rest between meals, The results in the study further indicates that 2.6% experienced diarrhoes and the same percentage faced headache.

Findings indicates that 2.6% experienced Nausea and vomiting and and same percentage faced taste changes after taking Tenofovir+Lamivudine+Nevrapine (TDF+3TC+NVP). Findings in table further indicates that majority of the patients in Bweyogere health centre III hospital take a combination of Tenofovir+Lamivudine+Efavirenz (TDF+3TC+EFV)

5.3 Findings on the weight of the respondents

The results from table above indicates that most of the respondents in the study are in the age brackets of 56-60 this represents that the patients are not underweight , this could be due to improved medical care , this results also further shows that ARVS  were working well ans therefore their health was improving despite of the effects of HIV /AIDS, this findings is also in line with Nabiryo et al. (2004)  who asserts that ARVS  improves on the quality of life of the patients apart from that  The lower number of underweight subjects found in this study was possibly due to improved medical care in terms of treatment and prevention of opportunistic infections at the centre and decreased HIV and AIDS stigma among PLHIV.

5.4 Findings on the weight of the respondents

The results from study indicates that most of the respondents in the study are in the age brackets of 56-60 this represents that the patients are not underweight , this could be due to improved medical care , this results also further shows that ARVS  were working well and therefore their health was improving despite of the effects of HIV /AIDS, this findings is also in line with Nabiryo et al. (2004)  who asserts that ARVS  improves on the quality of life of the patients apart from that  The lower number of underweight subjects found in this study was possibly due to improved medical care in terms of treatment and prevention of opportunistic infections at the centre and decreased HIV and AIDS stigma among PLHIV.

5.5 Findings on the Nutritional Status of the respondents

According to the study amount of consumption by females was at 47.3 ± 17.7gm while the male fat consumption in the tenth week was at 52.3±28.8gm while in the sixth week the fat consumption was at 19.6 ± 7.8gm and for the males was at 48.1±18.4gm for the females, WHO (2004) recommends for most adults, that oils and fat should supply at least 15% of their energy intake. Women of reproductive age should consume at least 20% their energy from fat. Therefore, based on the above recommendation it was calculated that the males require about 44.5 grams while the females require 53.3 grams of fat.

According to the WHO (2003) guidelines, there is no evidence that fat requirements are different during HIV infection. However, certain ARVs or certain infection symptoms such as diarrhoea may require changes in the timing or quantity of fat intake (FANTA, 2004). Although fats facilitate absorption and utilization of fat soluble vitamins such as A, E, K and D (MOH, 2006); their consumption should be limited due to the reason that excessive fat intake may predisposes individuals to obesity and obesity related complications.

Protein

According to the findings in the table above the results indicate that, female subjects had lower protein intake than the male subjects at all contacts however, both sexes met the daily recommended amount of protein intake. WHO (2003) suggest that proteins should contribute about 10-15% of the total caloric intake of individual, Adequate protein intake is important to maintain muscle mass and to regenerate liver cells in HIV positive people without cirrhosis. HIV positive people without cirrhosis may need up to two or three grams of protein per kilogram of body weight daily to regenerate liver cells (Fabris et al., 1988). Furthermore, adequate protein intake is also equally important for the gain of body cell mass (Williams, 2003).

Carbohydrate

Carbohydrate was the major energy source for the subjects throughout the study by contributing more than 55% of the total calorie that had been taken in 4.18. It is suggested that carbohydrates should contribute about 55-70% to the total caloric intake of an individual (WHO and FAO, 2003). Based on the above recommendation, the carbohydrate requirements of the subjects were calculated as 330 grams for females and 367 grams for males per day. Therefore the carbohydrate intake of both males and females was adequate. This is most likely due to the low dietary diversity among the participants which makes them to feed on some energy rich staple foods like tubers, plantains and cereals. Williams (2002) noted that carbohydrate intake was negatively associated with body cell mass. The reason for this is unclear although it is possible that patients whose diets include a greater proportion of carbohydrates consume a proportionally lower amount of protein (Bukusuba et al., 2007). Similarly, Williams et al. (2002) noted that greater protein intake is positively associated with BCM. Macallan et al. (1995) reported that poor dietary intake among HIV patients contributed to loss of lean mass or poor recovery among people with severe malnutrition.

Micronutrients

The study reveals that both females and males met the WHO requirements vitamin A intake in all contacts. The females had vitamin A intake of 2307.3±2812.1 μg, 1500.2±3193.3 μg and 1616.8±1820.7 μg at baseline, six weeks and ten weeks of treatment respectively. Meeting the requirements of Vitamin A is important for maintaining epithelial cells, mucous membranes and immune system function (Piwoz and Preble, 2000, Stepenson, 2001). On the other hand, long term consumption of vitamin A in excess of 10 times of RDA (25,000 IU/day) may cause side effects like nausea, headache, fatigue, loss of appetite, dizziness, dry skin, desquamation, cerebral edema and osteoporotic fracture (Penniston and Tanumihardjo, 2006). Although both males and females had almost the same intake of vitamin B1, the female subjects met their daily vitamin B1 requirements while the males only met 91.7%, 83.3% and 75.0% of the requirements at baseline, six weeks and ten weeks of treatment. The reason for not fulfilling the requirements is only that, males have higher vitamin B1 requirement than females (FAO/WHO, 1998). Both female and male subjects met their daily vitamin C requirements in all contacts. Meeting the requirements of Vitamin A especially in HIV patients helps the body to protect against opportunistic infections and also aids in recovery after infection (WHO and FAO, 2002).

4.16 Findings on changes in body mass index

4.16 Changes in Body mass index

There was a significant increase in body mass index all subjects from the baseline (22.7±4 kg/m2) to ten weeks of treatment (23.0±4.0 kg/m2; p=0.003) (Table 4.14). Unlike the males, female subjects showed significant increase in BMI (23.5±4.0 kg/m2; p=0.003) at the end of the study. The increase in BMI is most likely due to the effect of ART against immune suppression which leads to body recovery and weight gain among HIV positive individuals. The results are in agreement with the findings of Wanke et al. (1998) where majority of the HIV positive individuals treated with HAART showed an increase in BMI. Esposito et al. (2008) reported similar results in HIV patients, Body mass index tends to increase after initiation of HAART.

4.17 Findings on changes in body mass index

There was a significant increase in body mass index all subjects from the baseline (22.7±4 kg/m2) to ten weeks of treatment (23.0±4.0 kg/m2; p=0.003) (Table 4.14). Unlike the males, female subjects showed significant increase in BMI (23.5±4.0 kg/m2; p=0.003) at the end of the study.

4. 18 Changes in Mid-Upper Arm Circumference (MUAC)

The results show that there was a significant increase in overall Mid-Upper Arm Circumference after six weeks (27.6±3.6cm; p=0.003) and at ten weeks (27.6±3.3cm; p=0.017) of treatment. The female subjects also showed a significant increase (27.9±3.6cm; p=0.009) in MUAC after six weeks of treatment, While the males did not show any significant increase in MUAC after six and ten weeks of treatment. The significant change in MUAC shown in the female subjects could be showing females have good response towards HAART. A study in South Africa showed that HIV positive women showed a significant increase in mean MUAC after being treated with HAART for 24 weeks (Esposito, 2008). Therefore the increase in MUAC showed in the subjects was due to recovery and weight gain.

CHAPTER SIX

CONCLUSION AND RECONMENDATIONS

6.1 CONCLUSIONS

Antiretroviral treatment leads to an increase in overall weight, lean body mass, body fat and body cell mass in the first ten weeks of treatment. However the gain in the above body compartments could be in different proportions.

Most of the HIV positive patients who were on ARVS experienced an increase on body weight showing the ARVS had a good impact on the body.

Nutrition related side effects like headache, nausea/ vomiting and intense hunger are the most common among HIV patients starting ART.

Although patients starting antiretroviral treatment at Bweyogere meet their daily protein requirements, they had low energy intake and their dietary pattern was not constant during the first months of treatment this is shown by the fact their body weight was increasing showing a sign of the presence of balanced diet in their daily food.

6.2 Recommendations

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.

6.3 Area of further research

Further studies should be carried out on the long-term impacts of ARVS on the body weight.

Further studies also should be carried out on the relationship be between body weight and HIV

Studies of large enough sample size to assess body composition and dietary pattern changes according to HAART regimen, clinical staging of HIV infection and other morbidity factors should be conducted that may help the development of widely applicable guidelines.

Further studies focusing on food security and socioeconomic status of the PLHIV on first line antiretroviral should examine the determinants of the fluctuations in micronutrient intake, and dietary patterns in general.

APPENDIX I: BUDGET ESTIMATES

APPENDIX II: TIME PLAN

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APPENDIX III: QUESTIONNAIRE

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

Dear respondent

I am KIBIRIGE GORDON a student of Kyambogo University, am carrying out a study on the above stated topic. You are one of the respondents randomly selected to participate in the study. The information given shall be treated with at most confidentiality and shall only be used strictly for academic purpose.

SECTION A:             GENERAL DATA

1. Sex: a) Male                  b)  female
2. Age a) 18 -29 b) 30 – 39                   c)  40 -50 years
3. Educational level
4. a) Certificate b) Diploma                      c) Degree         d) Masters and above
5. Marital status
6. a) Married
7. b) Single
8. c) Divorced
9. d) Widowed
10. Occupation
11. Unemployed
12. salaried
13. formal employment
14. Informal business
15. Religion
16. catholic
17. Protestant
18. Muslim
19. Pentecostal
20. others

SECTION B

1. Household information
2. How many people, including you, live in your household, (Including yourself)?
3. A) 2
4. B) 3-4
5. C) 5-6
6. D) 7-8
7. E) 9-10
8. F) 11 and above
9. Sources of income for the house hold (circle that applies)
10. A) Farming
11. B) Salaried employee
12. C) Formal business owner
13. D) Unemployed
14. E) Informal Business

F)Other

3. What is the source of food consumed in your household? (Circle that applies)
4. A) Buying.
5. B) Own farm
6. C) Own farm and Buying
7. D) Food aid
8. C) Others (specify)
9. Does every household member share food available in the house?
10. Yes B. No

SECTION C:General HIV status Drug administration, health services and Life style.

1. How long ago you knew you are HIV positive?
2. A) <2yr B) 2yr to 3 yrs

1. C) 4yrs to 5yrs D) more than 5yrs

1. E) Don’t know

2. CD4 count at starting of the treatment? _________

SECTION D: Effect of specific ARVS drugs on nutritional status of client for the period of 6-10 weeks

1. What type of ARV combination do you receive?
2. A) Zidovudine+ Lamivudine + Nevirapine (ZDV+3TC + NVP) (Duovir-N)

1. B) Stavudine + Lamuvidine + Nevirapine( d4T+3TC + NVP) (Triomune )

1. C) Stavidine +Lamivudine + Evafrenz (d4T+3TC + EFZ)

1. D) Tenofovir+Lamivudine+Efavirenz (TDF+3TC+EFV)

1. E) Tenofovir+Lamivudine+Nevrapine (TDF+3TC+NVP)

1. F) Zidovudine+ Lamivudine + Efavirenz (ZDV+3TC + EFZ)

1. G) Other combination _____________________
2. Do you take the drugs exactly as you expected to take them?

1. A) Yes B) No

3. How many do you take in reality?

1. A) Exact number B) Part of them

1. C) Over dose D) other (specify)

4. How often are you expected to take them?

1. A) Daily B) Every other day

1. C) Every week D) other specify

5. What strange feeling do you experience after taking the drugs or other medications?

10. Other specify;………………………………………………………………………….

SECTION E: Nutritional Status

Food frequency

Which foods do you normally eat and how often do you eat them.

SECTION: F

A 24 Hour Dietary Recall

Please name all foods and drinks that youconsumed starting from morning to evening yesterday including at night.

What amount of foods and drinks did you consume stating method of preparation?

*Description of ingredients: 01=Fresh; 02=Dried; 03=Tinned; 04=Frozen; 05=Bottled; 06=Others(specify).

**Method of preparation: 01=Eaten raw; 02=Boiled; 03=Steamed; 04=Roasted; 05=Deep fried;

06=Shallow fried; 07=Baked; 08=Mingled; 09=Others (specify).

***Description of indicative local measure: 01=Handful; 02=Cupful; 03=Spoonful; 04=Plateful;

05=Counts (eggs, slices); 06=1/2Cup; 07=1/2Plate; 08=others (specify).

SECTION: G ANTHROPOMETRIC INDICES DURING THE DURATION OF 6-10 WEEKS ON ARVS

Anthropometric Data Body Composition Measurement

Thank You