Nutritional status and its associated factors among HIV positive adolescents on Atazanavir-based regimen attending an urban clinic in Uganda

Background Adolescents between the ages of 10-19 represent a growing portion of people living with HIV worldwide. A large proportion of adolescents living with HIV suffer from severe malnutrition because of the chronic ill health and this has been associated with increased morbidity and mortality particularly in Sub-Saharan Africa. Little is known about the nutrition status of adolescents living with HIV who are on second line treatment particularly Atazanavir. Therefore, we assessed the nutrition status and associated factors among HIV positive adolescents on Atazanavir-based regimen attending an urban clinic in Uganda. Method This was a cross-sectional study carried out between December 2017 and July 2018. Using convenience sampling, adolescents aged 10-19 years attending an urban clinic in Kampala on Atazanavir-based regimen were enrolled into the study. Nutritional status was assessed using BMI-for-Age and Height-for-age as measures of thinness and stunting respectively. Standard deviation scores (Z scores) were applied to determine the nutritional status. WHO and CDC Z-score cut offs were used to categorize the nutrition status. Data was entered into an electronic database using REDCap. Statistical analysis was done using STATA version 15.1 (Texas, USA). Results Data from 132 adolescents were included. We found that 28% were malnourished (composite outcome of stunting and thinness). The prevalence malnutrition of thinness was 7.6% with 2.3% being severely thin. The prevalence of stunting was 23.7% with 1.5% being severely stunted. Adolescents with no parent were more likely to be malnourished than adolescents who had either one or both parents (Adjusted Odds Ratio [AOR]: 3.70 95% Confidence Interval [CI]: 1.20-11.37, p=0.023). In addition, adolescents who had attained at least secondary education were less likely to be malnourished (AOR: 0.40, CI:0.17-0.95, P-value=0.037). Conclusion There is a high proportion of adolescents with HIV who are malnourished. Low level of education (No education and elementary) and having no parent are important risk factors to malnutrition in this population. There is need for optimizing nutrition care for adolescents on HIV treatment. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was supported by the Uganda Research Training Collaboration; a collaboration between Makerere University and University of Minnesota to mentor students in a research career. The funding bodies did not have a role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: 1. The study was approved by University of Minnesota Ethics Committee (STUDY00000414) 2. The study was approved by TASO Research Ethics (TASOREC/33/17-UG-REC-009) 3. The study was approved by Uganda National Council of Science and Technology (HS100ES). 4. Written Informed Consent was obtained from the participants. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes data available on request from the author * ATV : Atazanavir ART : Anti-Retroviral Therapy BAZ : Body Mass Index for Age z-scores HAZ : Height for Age z-scores HIV : Human Immune-deficiency Virus WHO : World Health Organization CDC : Center for Disease Control SD : Standard Deviation TASO : The AIDs Support Organization UOR : Unadjusted Odds Ratio AOR : Adjusted Odds Ratio CI : Confidence Interval TDF : Tenofovir ABC : Abacavir AZT : Zidovudine