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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 2004,HIV/AIDS,food insecurity,and malnutrition are synergistically inter-related,particularly in Africa,Malnutrition and
2、 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 periodic food
3、 shortages are common,Orphans and Malnutrition Proportion children malnourished,Zimbabwe 2003,Source:Zimbabwe National Nutrition and EPI Survey,Ministry of Health and Child Welfare,Feb 2003,Percent(%),How does HIV/AIDS affect nutrition?,Malnutrition and HIV work in tandemMacallan,Proc Nutr Soc,1999,
4、HIV compromises nutritional status,increases susceptibility to secondary infectionsMalnutrition exacerbates the effects of HIV by further weakening the immune system,HIV affects nutrition through multiple mechanisms,Increased energy requirements10%increase during asymptomatic infection20-30%increase
5、 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 increased nutrien
6、t utilization,How does nutrition affect HIV/AIDS?,Low food(energy)intake is a primary cause of weight loss and wasting in HIV Macallan,1999,Weight 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 strongly predict risk
7、 of illness and death in HIV+adults(graph),P 0.01 for all RR,Low intakes and deficiencies of several micronutrients associated with more rapid disease progression and mortality in HIV+adults,These include vitamins A,B1,B6,B12,C,E;folate;selenium;zinc(Tang et al,1993;1996;Baum et al,1997;Semba et al,
8、1994)MN requirements for PLWHA are not known(WHO 2003)1 RDA may be needed to correct nutritional deficiencieshowever 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 available,Tang et al,1996,Intake of Vit
9、amin B1 and survival of HIV+adults,What is the impact of nutrition intervention/improvement on HIV/AIDS progression,transmission,and survival?,Several studies show that high energy/protein food supplements improve weight gain,However,most weight gained is fat,not lean body massSupplements frequently
10、 replace diet,not add to it counseling neededIncreased protein intake does not prevent or reverse muscle 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 benefits,Reduced hospitalizations in adults(
11、Burbano et al,2003)Increased survival in adults with advanced disease(Jiamton et al,2003)Increased 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;2
12、003)Reduced MTCT in nutritionally and immunologically vulnerable(Fawzi et al,2002),Proportion of children from households with food deficits dropping out of school in previous year,Zimbabwe,2003,Source:Zimbabwe Emergency Food Security and Vulnerability Assessment-April 2003,ZIMBABWE Vulnerability As
13、sessment Committee,SADC FANRVulnerability,%of households with at least one child dropping out of primary school,Conclusions,There is a complex,synergistic relationship between malnutrition and HIV/AIDSHIV affects nutrition its impact begins early during asymptomatic infection and continues throughou
14、tNutrition interventions have shown a wide range of benefits on HIV-related outcomes.The impact depends on the type of intervention,duration,and underlying vulnerability/nutrition statusNutrition counseling,care and support is an important component of comprehensive HIV-care consider it from the out
15、set when planning programs,Nutrition and ARV Therapy,Nutrition-related side effects,such as nausea and vomiting affect adherence to HAART,particularly early in treatment(USA),Chen et al,CID,2003,Side effects were also a barrier to adherence to ARV therapy in BotswanaWieser et al,JAIDS,2003,Wasting is still a problem in patients on ARV therapy,
