{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:18:38Z","timestamp":1792027118530,"version":"4.4.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Underweight affects the overall clinical outcome and quality of life and increases the risk of mortalities in Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV\/AIDS) patients. Though studies have examined the various determinants of being underweight in people living with HIV\/AIDS (PLHIV), scanty evidence exists about the influence of dietary diversity scores and dietary counseling on underweight HIV patients in Ethiopia. This study aimed to identify the determinants of being underweight among adult patients receiving antiretroviral therapy at Bishoftu General Hospital, central Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An institution-based unmatched case-control study was conducted among 279 participants (93 cases and 186 controls) from April to May 2022. Cases were selected consecutively as they occur, and then two subsequent controls that visited the antiretroviral therapy(ART) clinic were interviewed until the sample size was attained. Data were collected using a pretested structured questionnaire and involved patient interviews and chart review. Bivariate and Multivariable logistic regression was used to identify determinants of underweight. The presence of statistically significant association was declared with p-value &lt;0.05, and a 95% confidence interval was used to show the precision in the measure of the strength of association.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The response rate of participants was 91.2% for each of the cases and controls. Monthly income of patients \u22642000 birr (AOR = 6.63, 95% CI: 2.96\u201314.85), absence of support giver (AOR = 3.22, 95% CI: 1.38\u20137.50), being having an eating problem (AOR = 14.48, 95% CI: 5.06\u201341.40), dietary diversity score of four to five (AOR = 2.36, 95% CI: 1.92, 6.08), not getting dietary counseling support and advice (AOR = 2.53, 95% CI: 1.11, 5.72) and chewing khat (AOR = 3.36, 95% CI: 1.99,11.33) were determinants of underweight in adult HIV patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study revealed that household dietary diversity, counseling and education on nutrition, monthly income, eating problems, support giver, and khat chewing were predictors of being underweight in HIV patients. This inquires an integrated nutritional intervention including income-generating activities, counseling and education on nutrition and bad habits, and regular monitoring of the nutritional status during clinic visits.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0291602","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T17:24:07Z","timestamp":1695317047000},"page":"e0291602","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors of underweight among adult patients receiving antiretroviral therapy in Bishoftu general hospital, central Ethiopia: Case-control study"],"prefix":"10.1371","volume":"18","author":[{"given":"Mesfin Gashaw","family":"Assefa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9297-0383","authenticated-orcid":true,"given":"Alem","family":"Deksisa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariama","family":"Abdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obse Tamiru","family":"Alemayehu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5465-6345","authenticated-orcid":true,"given":"Dawit Wolde","family":"Daka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"pone.0291602.ref001","first-page":"2012","article-title":"HIV and malnutrition: Effects on immune system","author":"S Duggal","year":"2012","journal-title":"Clin Dev Immunol"},{"key":"pone.0291602.ref002","first-page":"3","volume-title":"Malnutrition in HIV\/AIDS: Aetiopathogenesis","author":"VK Sashindran","year":"2020"},{"key":"pone.0291602.ref003","unstructured":"Better Health Channel. Body Mass Index (BMI) [Internet]. [cited 2022 Sep 18]. https:\/\/www.betterhealth.vic.gov.au\/health\/healthyliving\/body-mass-index-bmi"},{"issue":"8","key":"pone.0291602.ref004","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.jand.2013.02.005","article-title":"Effects of HIV and antiretroviral therapy on resting energy expenditure in adult HIV-infected women-A matched, prospective, cross-sectional study","volume":"113","author":"AL Mittelsteadt","year":"2013","journal-title":"J Acad Nutr Diet"},{"key":"pone.0291602.ref005","unstructured":"World Health Organization. Nutrient requirements for people living with HIV\/AIDS. Report of a technical consultation World Health Organization, Geneva, 13\u201315 May 2003. 2003."},{"key":"pone.0291602.ref006","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40795-020-00334-x","article-title":"Undernutrition among Ethiopian adults living with HIV: A meta-analysis","volume":"6","author":"A Alebel","year":"2020","journal-title":"BMC Nutr"},{"key":"pone.0291602.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-020-05706-z","article-title":"Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis","volume":"21","author":"A Alebel","year":"2021","journal-title":"BMC Infect Dis"},{"key":"pone.0291602.ref008","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12981-017-0186-3","article-title":"Hospitalization causes and outcomes in HIV patients in the late antiretroviral era in Colombia","volume":"14","author":"MF \u00c1lvarez Barreneche","year":"2017","journal-title":"AIDS Res Ther"},{"key":"pone.0291602.ref009","doi-asserted-by":"crossref","first-page":"e048022","DOI":"10.1136\/bmjopen-2020-048022","article-title":"Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis","volume":"11","author":"A Alebel","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0291602.ref010","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1186\/s12913-019-4474-6","article-title":"Loss to follow-up and associated factors among adult people living with HIV at public health facilities in Wakiso district, Uganda: A retrospective cohort study","volume":"19","author":"D Opio","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0291602.ref011","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13104-019-4154-y","article-title":"Incidence and predictors of loss to follow-up among HIV infected adults after initiation of first line anti-retroviral therapy at University of Gondar comprehensive specialized Hospital Northwest Ethiopia, 2018: Retrospective follow up study","volume":"12","author":"N Mekonnen","year":"2019","journal-title":"BMC Res Notes"},{"key":"pone.0291602.ref012","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40795-019-0284-9","article-title":"Determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a case-control study design","volume":"5","author":"A Negessie","year":"2019","journal-title":"BMC Nutr"},{"key":"pone.0291602.ref013","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2147\/HIV.S292902","article-title":"Underweight and its predictors among patients on anti retroviral therapy at selected health facilities of Addis Ababa, Ethiopia, 2020","volume":"13","author":"AT Sahile","year":"2021","journal-title":"HIVAIDS\u2014Res Palliat Care"},{"issue":"4","key":"pone.0291602.ref014","doi-asserted-by":"crossref","first-page":"e58595","DOI":"10.1371\/journal.pone.0058595","article-title":"Predictors of Change in CD4 Lymphocyte Count and Weight among HIV Infected Patients on Anti-Retroviral Treatment in Ethiopia: A Retrospective Longitudinal Study","volume":"8","author":"AA Reda","year":"2013","journal-title":"PLoS ONE"},{"issue":"May","key":"pone.0291602.ref015","first-page":"2","article-title":"Effects of nutritional supplementation for HIV patients starting antiretroviral treatment: Randomised controlled trial in Ethiopia","volume":"348","author":"MF Olsen","year":"2014","journal-title":"BMJ Online"},{"key":"pone.0291602.ref016","unstructured":"Ministry of Health of Ethiopia. National Consolidated Guidelines for Comprehensive HIV Prevention, Care and Treatment. 2018."},{"key":"pone.0291602.ref017","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1155\/2020\/7360190","article-title":"Assessment of Prevalence of Malnutrition and Its Associated Factors among AIDS Patients from Asella, Oromia, Ethiopia","volume":"2020","author":"T Teklu","year":"2020","journal-title":"BioMed Res Int"},{"issue":"5","key":"pone.0291602.ref018","first-page":"35","article-title":"Undernutrition and associated factors among adults human immunodeficiency virus positive on antiretroviral therapy in hospitals, East Hararge Zone, Oromia, Ethiopia: A cross-sectional study","volume":"11","author":"M Dedha","year":"2017","journal-title":"Int J Health Sci"},{"key":"pone.0291602.ref019","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2147\/HIV.S222611","article-title":"Prevalence of undernutrition and associated factors among adults receiving first-line antiretroviral treatment in public health facilities of Arba Minch Town, Southern Ethiopia","volume":"11","author":"B Oumer","year":"2019","journal-title":"HIVAIDS\u2014Res Palliat Care"},{"issue":"8","key":"pone.0291602.ref020","first-page":"67","article-title":"Undernutrition and its predictors among people living with HIV\/AIDS attending antiretroviral therapy clinic in Jimma University Specialized Hospital","volume":"9","author":"M Sinaga Teshome","year":"2017","journal-title":"Int J Nutr Metab"},{"key":"pone.0291602.ref021","unstructured":"EPHIA. Ethiopia Population-Based HIV Impact Assessment EPHIA 2017\u20132018. 2018."},{"issue":"4","key":"pone.0291602.ref022","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/tmi.12679","article-title":"Economic burden of underweight and overweight among adults in the Asia-Pacific region: A systematic review","volume":"21","author":"ME Hoque","year":"2016","journal-title":"Trop Med Int Health"},{"key":"pone.0291602.ref023","unstructured":"Kennedy, G., Terri, Ballard and MarrieClaude D. Guidelines for measuring household and individual dietary diversity. Nutrition and Consumer Protection Division, Food and Agriculture Organization of the United Nations. FAO. 2010. 1\u201360 p."},{"key":"pone.0291602.ref024","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2147\/NDS.S276311","article-title":"Determinants of Undernutrition Among Adult People on Antiretroviral Therapy in Goba Hospital, Southeast Ethiopia: A Case\u2013Control Study","volume":"12","author":"FS Kalil","year":"2020","journal-title":"Nutr Diet Suppl"},{"key":"pone.0291602.ref025","unstructured":"UNAIDS. Nutrition assessment, counselling and support for Nutrition assessment, counselling and support for adolescents and adults living with HIV: A Programming Guide. Food and Nutrition in the Context of HIV and TB. 2014."},{"key":"pone.0291602.ref026","unstructured":"World Health Organization. The WHO STEPwise approach to noncommunicable disease risk factor surveillance. 2020."},{"key":"pone.0291602.ref027","unstructured":"World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2007."},{"issue":"3","key":"pone.0291602.ref028","doi-asserted-by":"crossref","first-page":"155","DOI":"10.5001\/omj.2011.38","article-title":"Patient medication adherence: measures in daily practice","volume":"26","author":"B Jimmy","year":"2011","journal-title":"Oman Med J"},{"key":"pone.0291602.ref029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/2055-0928-1-5","article-title":"Prevalence of malnutrition and its associated factors among adult people living with HIV \/ AIDS receiving anti-retroviral therapy at Butajira Hospital, southern Ethiopia","volume":"1","author":"D Gedle","year":"2015","journal-title":"BMC Nutr"},{"key":"pone.0291602.ref030","doi-asserted-by":"crossref","first-page":"299","DOI":"10.2147\/PPA.S298594","article-title":"Adherence and Its Associated Factors Among Adult HIV-Infected Patients on Antiretroviral Therapy in South Western Ethiopia, 2020","volume":"15","author":"AT Angelo","year":"2021","journal-title":"Patient Prefer Adherence"},{"key":"pone.0291602.ref031","first-page":"16","article-title":"Tobacco smoking and alcohol drinking among HIV infected people using antiretroviral therapy","volume":"16","author":"DN Bhatta","year":"2018","journal-title":"Tob Induc Dis"},{"key":"pone.0291602.ref032","article-title":"smoking","author":"Matthew J. Hilton","year":"2023","journal-title":"Encyclopedia Britannica"},{"key":"pone.0291602.ref033","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/9858619","article-title":"Reducing Undernutrition through Counseling on Diversified Food Intake among Adult People Living with HIV on HAART, Northern Ethiopia","volume":"2020","author":"WH Tedla","year":"2020","journal-title":"J Nutr Metab"},{"key":"pone.0291602.ref034","unstructured":"Birhanu EB. Nutritional status and associated factors among adult HIV patients taking art from health facilities of Ylmanadensa district, northwest Ethiopia, 2020. A Thesis Submitted in partial Fulfillment of the Requirements for the Degree of Master of Science in app. 2020."},{"key":"pone.0291602.ref035","doi-asserted-by":"crossref","first-page":"859","DOI":"10.2147\/HIV.S278855","article-title":"Dietary diversity and associated factors among adult hiv positive patients on anti-retroviral therapy in public hospitals of kembata tembaro zone, Southern Ethiopia","volume":"12","author":"M Markos","year":"2020","journal-title":"HIVAIDS\u2014Res Palliat Care"},{"issue":"05","key":"pone.0291602.ref036","doi-asserted-by":"crossref","first-page":"1","DOI":"10.35248\/2329-891X.19.7.324","article-title":"Level of Dietary Diversity and Associated Factors among Adult Patients on HAART at Public Health Facilities of Ambo town, West Shoa Zone Ethiopia","volume":"07","author":"K Taye","year":"2019","journal-title":"J Trop Dis"},{"issue":"08","key":"pone.0291602.ref037","doi-asserted-by":"crossref","first-page":"6","DOI":"10.4172\/2155-6113.1000490","article-title":"Factors Associated with Dietary Diversity among HIV Positive Adults (> = 18 years) Attending ART Clinic at Mettema Hospital, Northwest Ethiopia: Cross-sectional Study","volume":"06","author":"AT Woldemariam","year":"2015","journal-title":"J AIDS Clin Res"},{"issue":"6","key":"pone.0291602.ref038","first-page":"10","volume":"7","author":"M Beatrice","year":"2018","journal-title":"Factors Affecting Dietary Intake and Dietary Diversity Score Among Adults Living With HIV\/AIDS in Uasin Gishu District Hospital, Kenya-A Cross Sectional Study"},{"issue":"2","key":"pone.0291602.ref039","doi-asserted-by":"crossref","first-page":"e000714","DOI":"10.1136\/bmjopen-2011-000714","article-title":"Structural determinants of food insufficiency, low dietary diversity and BMI: a cross-sectional study of HIV-infected and HIV-negative Rwandan women","volume":"2","author":"N Sirotin","year":"2012","journal-title":"BMJ Open"},{"key":"pone.0291602.ref040","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/0778-7367-71-13","article-title":"Malnutrition: Prevalence and its associated factors in People living with HIV\/AIDS, in Dilla University Referral Hospital","volume":"71","author":"S Hailemariam","year":"2013","journal-title":"Arch Public Health"},{"key":"pone.0291602.ref041","first-page":"9","article-title":"Under nutrition and Associated Factors among Adult Individuals Receiving Highly Active Antiretroviral Therapy in Health Facilities of Nekemte Town, Eastern Ethiopia","volume":"70","author":"A Edosa","year":"2017","journal-title":"Food Sci Qual Manag"},{"key":"pone.0291602.ref042","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2147\/HIV.S286609","article-title":"Episodes of undernutrition and its predictors among clients on antiretroviral treatment in southwest ethiopia: A record review","volume":"13","author":"AO Abdu","year":"2021","journal-title":"HIVAIDS\u2014Res Palliat Care"},{"key":"pone.0291602.ref043","first-page":"1","article-title":"The HIV wasting syndrome","author":"GS Reiter","year":"1996","journal-title":"NEJM"},{"key":"pone.0291602.ref044","unstructured":"WebMD. AIDS Wasting Syndrome: Symptoms, Causes, Treatments [Internet]. [cited 2022 Sep 23]. https:\/\/www.webmd.com\/hiv-aids\/guide\/aids-wasting-syndrome"},{"key":"pone.0291602.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2325958220976254","article-title":"Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study","volume":"19","author":"AN Tekelehaimanot","year":"2020","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"pone.0291602.ref046","unstructured":"East, Central, and Southern African Health Community (ECSA-HC), Food and Nutrition Technical Assistance Project (FANTA) and LP. Nutrition and HIV\/AIDS: A Training Manual for Nurses and Midwives. Arusha, Tanzania: ECSA-HC. 2008."},{"key":"pone.0291602.ref047","unstructured":"World Bank. HIV\/AIDS, Nutrition, and Food Security: What we can do. A synthesis of international guidance. 2007."},{"issue":"2","key":"pone.0291602.ref048","first-page":"123","article-title":"Association between khat chewing and gastrointestinal disorders: a cross sectional study","volume":"23","author":"T Nigussie","year":"2013","journal-title":"Ethiop J Health Sci"},{"key":"pone.0291602.ref049","doi-asserted-by":"crossref","first-page":"6361","DOI":"10.4081\/hls.2018.6361","article-title":"Assessment of nutritional status and its associated factors among people affected by human immune deficiency virus on antiretroviral therapy: a cross sectional study in Siltie zone, south Ethiopia","volume":"6","author":"MS Saliya","year":"2018","journal-title":"Healthc Low-Resour Settings"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291602","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T17:24:48Z","timestamp":1695317088000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291602"}},"subtitle":[],"editor":[{"given":"Steve","family":"Zimmerman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0291602","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,21]]}}}