Nutritional status and functional capacity among people living with HIV in routine care: a retrospective cohort study

Abstract

Background: Malnutrition remains an important concern among people living with HIV (PLHIV), even with widespread antiretroviral therapy (ART). Although ART has improved survival and long-term outcomes, undernutrition persists alongside increasing overweight and obesity, creating a dual nutritional burden that may complicate HIV care. This study described the nutritional status of adults receiving routine HIV care in a tertiary facility in Nigeria. Methods: We conducted a retrospective cohort study using routinely collected clinical data from the HAART clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Adults aged ≥ 18 years with complete anthropometric measurements at the index visit were included. For participants with multiple encounters, the index visit was the earliest visit with available body mass index (BMI) data. Nutritional status was classified using standard adult BMI categories. Baseline demographic, anthropometric, treatment, and laboratory characteristics were summarized descriptively. Because laboratory variables had substantial missingness and functional status showed limited variability, adjusted regression analyses were not performed. Results: Of 1,132 patient records screened, 301 participants met the eligibility criteria. The median age was 52 years [interquartile range (IQR): 45-60 years], and 98.7% were male. Overall, 26 participants (8.6%) were underweight, 165 (54.8%) had normal BMI, 75 (24.9%) were overweight, and 35 (11.6%) were obese. Most participants were receiving tenofovir-lamivudine-dolutegravir (TLD)-based therapy (87.7%). WHO functional status showed no variability; all participants were classified as working. CD4 count and viral load data were available for only 3.7 and 13.3% of participants, respectively. Conclusion: Undernutrition persists alongside overweight and obesity among adults receiving routine HIV care. The coexistence of nutritional deficits and excess weight supports routine nutritional assessment within long-term HIV care. Given substantial missing laboratory data, lack of functional-status variability, and extreme sex imbalance, findings should be interpreted primarily as descriptive observations.