Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis

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Abstract

Background

Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA.

Methods

A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I ² statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio.

Results

Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV.

Conclusion

This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-020-05706-z.

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The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2009)

Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

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HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

Ayesha B.M. Kharsany, Quarraisha Karim (2016)

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

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Quantifying publication bias in meta-analysis.

Lifeng Lin, Haitao Chu (2018)

Publication bias is a serious problem in systematic reviews and meta-analyses, which can affect the validity and generalization of conclusions. Currently, approaches to dealing with publication bias can be distinguished into two classes: selection models and funnel-plot-based methods. Selection models use weight functions to adjust the overall effect size estimate and are usually employed as sensitivity analyses to assess the potential impact of publication bias. Funnel-plot-based methods include visual examination of a funnel plot, regression and rank tests, and the nonparametric trim and fill method. Although these approaches have been widely used in applications, measures for quantifying publication bias are seldom studied in the literature. Such measures can be used as a characteristic of a meta-analysis; also, they permit comparisons of publication biases between different meta-analyses. Egger's regression intercept may be considered as a candidate measure, but it lacks an intuitive interpretation. This article introduces a new measure, the skewness of the standardized deviates, to quantify publication bias. This measure describes the asymmetry of the collected studies' distribution. In addition, a new test for publication bias is derived based on the skewness. Large sample properties of the new measure are studied, and its performance is illustrated using simulations and three case studies.

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Author and article information

Contributors

Animut Alebel:

ORCID: http://orcid.org/0000-0003-2822-2062

animut.a23@gmail.com

Daniel Demant: Daniel.Demant@uts.edu.au

Pammla Petrucka: pammla.petrucka@usask.ca

David Sibbritt: David.Sibbritt@uts.edu.au

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 4 January 2021

Publication date PMC-release: 4 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 1

Affiliations

[1 ]GRID grid.449044.9, ISNI 0000 0004 0480 6730, College of Health Science, , Debre Markos University, ; Debre Markos, Ethiopia

[2 ]GRID grid.117476.2, ISNI 0000 0004 1936 7611, School of Public Health, Faculty of Health, , University of Technology Sydney, ; Ultimo, NSW Australia

[3 ]GRID grid.1024.7, ISNI 0000000089150953, School of Public Health and Social Work, Faculty of Health, , Queensland University of Technology, ; Kelvin Grove, NSW Australia

[4 ]GRID grid.25152.31, ISNI 0000 0001 2154 235X, College of Nursing, , University of Saskatchewan, ; Saskatoon, Canada

[5 ]GRID grid.451346.1, ISNI 0000 0004 0468 1595, School of Life Sciences and Bioengineering, , Nelson Mandela African Institute of Science and Technology, ; Arusha, Tanzania

Author information

Animut Alebel http://orcid.org/0000-0003-2822-2062

Article

Publisher ID: 5706

DOI: 10.1186/s12879-020-05706-z

PMC ID: 7780691

PubMed ID: 33390160

SO-VID: de014cb8-305c-48c9-9120-ee951c24d8dc

License:

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