Clinical, lifestyle, environmental and dietary determinants of malnutrition in adolescents on antiretroviral therapy in Ethiopia

Adolescence is a critical period for growth and development, and adequate nutrition is essential for adolescents living with HIV (ALHIV) receiving antiretroviral therapy (ART). This study examined factors associated with malnutrition among ALHIV receiving ART in Ethiopia. A facility-based cross-sectional study included 384 ALHIV aged 10-19 years attending ten public hospitals in Addis Ababa and Oromia from August to December 2023. Data were collected using a structured questionnaire, clinical assessments, and record reviews. Multivariable logistic regression identified factors associated with malnutrition. Overall, 24.2% of participants were thin, 21.7% were stunted, and 34.9% were acutely malnourished. Females had lower odds of thinness (AOR = 0.27; 95% CI: 0.16-0.45). Absence of chronic infections (AOR = 0.48; 95% CI: 0.29-0.80), absence of anxiety symptoms (AOR = 0.53; 95% CI: 0.32-0.88), and nutritional supplementation (AOR = 0.55; 95% CI: 0.32-0.95) were associated with lower odds of thinness, whereas food insecurity increased the odds (AOR = 1.63; 95% CI: 1.02-2.62). Acute malnutrition was associated with younger age (10-17 years) (AOR = 1.94; 95% CI: 1.03-3.64), larger household size (AOR = 2.27; 95% CI: 1.23-4.17), shorter duration of HIV status awareness (AOR = 2.96; 95% CI: 1.62-5.40), low haemoglobin levels (AOR = 7.29; 95% CI: 1.31-40.5), food insecurity (AOR = 1.85; 95% CI: 1.09-2.14), and low meal frequency (AOR = 1.86; 95% CI: 1.08-3.19) were associated with increased odds of acute malnutrition. Females (AOR = 0.58; 95% CI: 0.38-0.88), absence of anxiety symptoms (AOR = 0.50; 95% CI: 0.28-0.89), and nutritional supplementation were protective against acute malnutrition (AOR = 0.45; 95% CI: 0.36-0.79). Malnutrition among ALHIV receiving ART in Ethiopia is influenced by clinical, socioeconomic, and dietary factors. Integrated nutrition, clinical care, and food security interventions are needed to improve outcomes.