Does nutrition have a role in HIV/AIDS?
These linkages suggest that nutrition may have an important role to play in slowing progression to AIDS and in contributing to successful antiretroviral (ARV) therapy. HIV and AIDS can also inhibit a person’s ability to secure adequate nutrition through inability to work, loss of appetite or increased need for nutrients as a result of the disease itself.
Interactions between antiretroviral therapy (ART) and food and nutrition can affect medication efficacy, nutritional status, and adherence to drug regimens.
Given the high prevalence of malnutrition in many countries where the HIV epidemic is an important contributor to morbidity and mortality, the interaction between the disease and nutrition make this an important area of study. However, while a number of HIV-related nutrition interventions have been piloted and implemented, the benefits of such interventions have not been rigorously investigated.
Studies have shown that the energy needs of HIV-infected individuals increase, even when showing no symptoms, and opportunistic infections lead to higher protein and micronutrient utilisation.
In addition, the acute phase response produces changes in levels of micronutrients and some associated proteins, which do not necessarily represent a deficiency in stores of these micronutrients. This makes it difficult to accurately assess the nutritional status of people living with HIV and AIDS (PLWHA).
Weight loss is a very strong predictor of mortality and in turn viral load a strong predictor of weight loss. Although ARVs can contribute to the maintenance of health and avoidance of weight loss, malnutrition and wasting are still common, even among HIV-infected patients on ARV treatment in developed countries. ARVs may also impact on the absorption and metabolism of foods and so influence nutritional status and body composition.
There is little research on the interactions between micronutrients and ARVs. Nevertheless, multiple micronutrient supplementation has been shown to have beneficial effects in a number of HIV related parameters, such as incidence of diarrhoea, progression to AIDS and mortality. Additionally, multivitamins have been shown to significantly improve child CD4 counts over time. The data suggests that multivitamins may delay the onset of AIDS and extend the time before ARV therapy becomes necessary.
The provision of multivitamins could be a cost-effective intervention, but the best formulation for different disease stages of multiple micronutrient supplementation still needs to be established.
Counselling can improve nutrition and help to maintain health. While the individual shows no symptoms, counselling may help in maintaining weight. During the later stages of the disease, it can assist with the management of problems associated with opportunistic infections.
There are three types of targeted nutrition supplements: micronutrients, food rations to manage mild weight loss, and therapeutic feeding for rehabilitation of moderate and severe malnutrition. Multiple micronutrient supplementation at RDA (recommended daily allowance) levels is a relatively cheap intervention that does not have large logistical implications. However, the ideal content of the supplementation for PLWHAs is still unknown.
The benefit of food supplementation is still to be evaluated. While there have been a number of food supplementation programmes linked to HIV and AIDS, there has been no clear assessment of the biological benefits of these programmes to HIV-infected individuals. However, supplementary feeding may be beneficial in assisting compliance with ARV treatment, providing social support and encouraging PLWHA to access services more often. The aim of food assistance must therefore be clearly identified: is it for nutrition benefit, economic support or social support?
Therapeutic feeding has been found to be effective in reversing moderate and acute malnutrition, but relapses are frequent once the patient returns to the environment that led to the malnutrition. It is also extremely expensive. There is therefore a need to strengthen community coping mechanisms/safety nets.
A key factor in the effectiveness of nutrition interventions on body weight in PLWHAs is the stage of disease progression. However, the lack of widespread voluntary counselling and testing, particularly in many African countries, means that individuals may not know their status. This is compounded by fear of stigma and discrimination, which prevents people from testing for HIV. As a result, individuals are accessing services at later stages of the disease’s progression, which reduces the effectiveness of interventions.