Food Nutrition and HIVAIDS

1、food, nutrition and hiv/aids:evidence and priority actions for hiv prevention, care and treatment programs ellen piwoz and peter salama summer seminar series, usaid washington, august 2004hiv/aids, food insecurity, and malnutrition are synergistically inter-related, particularly in africamalnutritio

2、n and food insecurity are endemic in africa, where more than 25 million people are living with hivnearly 40% of african children 50% also suffer from micronutrient deficiency disordersmalnutrition is not limited to children 50% of all pregnant women are anemichigh dependency on single crops and peri

3、odic food shortages are commonorphans and malnutrition proportion children malnourished, zimbabwe 2003source: zimbabwe national nutrition and epi survey, ministry of health and child welfare, feb 2003percent (%)how does hiv/aids affect nutrition?malnutrition and hiv work in tandemmacallan, proc nutr

4、 soc, 1999 hiv compromises nutritional status, increases susceptibility to secondary infections malnutrition exacerbates the effects of hiv by further weakening the immune systemhiv affects nutrition through multiple mechanismsincreased energy requirements10% increase during asymptomatic infection20

5、-30% increase during secondary infections50-100% increase for children (who, 2003)reductions in dietary intakedue to appetite loss, depression, oral sores food insecurity/loss of livelihoodsnutrient malabsorption and losshiv-infection of gi cells diarrhea-related losses metabolic changesimpaired and

6、 increased nutrient utilization how does nutrition affect hiv/aids?low food (energy) intake is a primary cause of weight loss and wasting in hiv macallan, 1999weight loss may be gradual or rapid with acute oi energy requirements are increased in hiv (who, 2003)weight loss and loss of lean body mass

7、strongly predict risk of illness and death in hiv+ adults (graph)weight loss over a 4-month time interval independently predicted illness and death in us adults wheeler et al, jaids, 19981.191.891.262.2201230-5% loss5-10% lossadj rrillnessdeathp 1 rda may be needed to correct nutritional deficiencie

8、showever there is concern that high doses of some nutrients may cause adverse outcomes (e.g., vitamin a, iron, zinc).recommendation of 1 rda until more data availabletang et al, 1996intake of vitamin b1 and survival of hiv+ adultswhat is the impact of nutrition intervention/improvement on hiv/aids p

9、rogression, transmission, and survival?several studies show that high energy/protein food supplements improve weight gain however, most weight gained is fat, not lean body mass supplements frequently replace diet, not add to it counseling needed increased protein intake does not prevent or reverse m

10、uscle wasting no increased protein requirement in hiv (who 2003)stack et al, 1996; piwoz and preble, 2000 mn supplementation studies have shown a wide range of benefitsreduced hospitalizations in adults (burbano et al, 2003)increased survival in adults with advanced disease (jiamton et al, 2003) inc

11、reased weight gain in hiv+ pregnant women (villamor et al, 2002)reduced morbidity and mortality in hiv+ children (vitamin a coutsoudis et al, 1995)improved birth outcomes and infant immune status (fawzi et al, 1998; 2003)reduced mtct in nutritionally and immunologically vulnerable (fawzi et al, 2002

12、)proportion of children from households with food deficits dropping out of school in previous year, zimbabwe, 2003source: zimbabwe emergency food security and vulnerability assessment - april 2003, zimbabwe vulnerability assessment committee, sadc fanrvulnerability% of households with at least one c

13、hild dropping out of primary schoolconclusionsthere is a complex, synergistic relationship between malnutrition and hiv/aidshiv affects nutrition its impact begins early during asymptomatic infection and continues throughoutnutrition interventions have shown a wide range of benefits on hiv-related o

14、utcomes. the impact depends on the type of intervention, duration, and underlying vulnerability/nutrition statusv nutrition counseling, care and support is an important component of comprehensive hiv-care consider it from the outset when planning programsnutrition and arv therapynutrition-related si

15、de effects, such as nausea and vomiting affect adherence to haart, particularly early in treatment (usa)reasonstopped 90 d(n=184)overall(n=24)toxicity-nausea/vomiting-anemia-p. neuropathy-gi side effects-lipodystrophy35 (62.5)14 (25.0)10 (17.9)03 (5.4)082 (44.6)17 (9.2)7 (3.8)17 (9.2)11 (6.0)9 (4.9)117 (48.8)31 (12.9)17 (7.1)17 (7.1)14 (5.8)9 (3.8)poor adherence/virologic failure8 (14.3)46 (25)54 (22.5)financial constraints2 (3.6)11 (6.0)13 (5.4)chen et al, cid, 2003side effects were also a barrier to adherence to arv