Prevalence and associated factors of malnutrition among adults living with HIV on ART: a pilot study

Antiretroviral therapy (ART) is widely used in the management of people living with human immunodeficiency virus (HIV) and has substantially improved clinical outcomes and reduced mortality. However, despite these benefits, individuals receiving ART remain at risk of malnutrition. This pilot study aimed to assess the prevalence of malnutrition and depressive symptoms, as well as patterns of physical activity and appetite, among people living with HIV (PWH) on ART, in a Greek population.

A total of 44 PWH on ART participated in the study. Malnutrition was evaluated using three validated screening tools, namely the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Assessment (SGA). Depressive symptoms, appetite status, dietary intake and knowledge, and physical activity levels (PAL) were assessed using the Beck Depression Inventory (BDI), the Council on Nutrition Appetite Questionnaire (CNAQ), and the Athens Physical Activity Questionnaire (APAQ), respectively. Multivariate and univariate regression analyses examined associations between malnutrition risk and sociodemographic and clinical variables. K-means clustering was used to identify participant phenotypes based on nutritional and lifestyle characteristics.

The prevalence of malnutrition was low, at 4.5% according to MNA and MUST, but 0% according to the SGA, with poor concordance observed between the three screening tools. Higher depressive symptom scores were independently associated with increased odds of malnutrition, while greater PAL were associated with reduced risk. K-means clustering identified two distinct phenotypic groups; younger participants with lower BMI, and lower PAL showed increased risk of malnutrition according to MUST (p = 0.003) and MNA (p = 0.006).

Although malnutrition prevalence was low, it was associated with greater depressive symptoms, lower PAL and BMI, and younger age, underscoring the need for comprehensive, multidimensional assessment and integrated care approaches addressing nutritional, psychological, and lifestyle factors.