Desempenho dos critérios da glim na avaliação da desnutrição em pessoas vivendo com o HIV

Abstract

Malnutrition remains a prevalent condition among people living with HIV, even in the era of antiretroviral therapy, and is associated with a higher risk of opportunistic infections, functional impairment, and reduced quality of life. Nutritional assessment in this population is therefore fundamental for the early identification of nutritional risk and for guiding appropriate interventions. However, there is no international consensus on the ideal method for diagnosing malnutrition in adults, which motivated the proposal of the Global Leadership Initiative on Malnutrition (GLIM) criteria as a universal diagnostic standard. Despite their potential applicability, there is a scarcity of studies validating these criteria in people living with HIV, especially in comparison with already established clinical instruments, such as the Patient Generated Subjective Global Assessment (PGS-SGA). Objective: This study aimed to evaluate the diagnostic performance and agreement of the GLIM criteria in identifying malnutrition in people living with HIV, using the PPS-SGA as the reference method. Methods: This is a cross sectional study conducted with adults followed up in a specialized HIV/AIDS outpatient service. Participants were assessed for nutritional status using the SGA-PPP and GLIM criteria, in addition to anthropometric measurements and clinical parameters related to nutritional status. Sensitivity, specificity, predictive values, likelihood ratios, Kappa concordance index, and ROC curve were analyzed to estimate the overall accuracy of the GLIM. Results: The results demonstrated that the GLIM criteria presented high specificity and high positive predictive value, configuring themselves as a suitable instrument for diagnostic confirmation of malnutrition. On the other hand, the SGA PPP showed greater sensitivity, a characteristic compatible with a nutritional screening instrument. Moderate agreement was observed between the methods, indicating that they are not interchangeable, but complementary. The ROC curve indicated good overall accuracy of the GLIM. Conclusion: It is concluded that the sequential use of the SGA-PPP followed by the GLIM criteria represents a more appropriate strategy for nutritional assessment in PLHIV, combining sensitive screening with objective diagnostic confirmation. However, further studies with different populations and longitudinal designs are needed to consolidate the clinical applicability of the GLIM criteria in this group.