HIVAIDS AND NUTRITION: An Update On Current Knowledge

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Link between Nutrition and HIV/AIDS


Nutrition and HIV/AIDS A Training Manual Session
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Acknowledgment

• Most of the slides in this presentation are the
  work of Ellen Piwoz (and Elizabeth Preble) of the
  SARA Project, Academy for Education Development

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Purpose

• To provide basic concepts of the relationship
  among food, nutrition, and HIV/AIDS general
  dietary needs and practices to reduce morbidity,
  mortality, and the progression of HIV to AIDS

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Session Outline

• Link between HIV/AIDS and nutrition
• Effects of HIV/AIDS on nutrition
• Effects of nutrition (macronutrients,
  micronutrients and existing nutritional status)
  on HIV/AIDS

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Vicious Cycleof Malnutrition and HIV
Source Adapted from RCQHC and FANTA 2003
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Effects of Malnutrition and HIV on the Immune
System

• Malnutrition HIV
• CD4 T-lymphocyte number
• CD8 T-lymphocyte number
• Delayed cutaneous hypersensitivity
• CD4/CD8 ratio
• Serologic response after immunizations
• Bacteria killing

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Affects of HIV/AIDS on Nutrition

• Decrease in the amount of food consumed
• Impaired nutrient absorption
• Changes in metabolism

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Causes of DecreasedFood Consumption

• Mouth and throat sores
• Loss of appetite leading to fatigue, depression,
  and changes in mental state
• Side effects from medication
• Abdominal pain
• Household food insecurity and poverty

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Poor Nutrient Absorption

• Nutrient absorption impaired during many
  infections
• Poor absorption of fats and carbohydrates at all
  stages of HIV infection because of
• HIV infection of intestinal cells
• Frequent diarrhea and vomiting
• Opportunistic infections
• Poor absorption of fats that affects use of
  fat-soluble vitamins such as A and E

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Changes in Metabolism

• Infection increases energy (10-15) and protein
  (50 or more) requirements
• Infection increases demand for and utilization of
  antioxidant vitamins (E, C, beta-carotene) and
  minerals (zinc, selenium, iron)
• Insufficient antioxidants from increased
  utilization causes oxidative stress
• Increases HIV replication
• Leads to higher viral loads

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HIV-Associated Wasting Syndrome

• Body weight is the most common body
• composition measurement but is
• inaccurate because of
• Fluid overload (e.g., severe renal disease, IV
  rehydration)
• Fluid deficits (e.g., dehydration from diarrhea,
  poor fluid intake)
• Inability to differentiate between changes in
  lean tissues or fat

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HIV-AssociatedWasting Syndrome, Cont.

• Body cell mass is superior to body weight
• Measures the metabolically active tissue
  compartment in the body
• Includes the muscles, organs, and circulating
  cells and so can differentiate between lean
  tissues and fat
• Studies show
• Progressive depletion of body cell mass in the
  late stages of HIV disease (Kotler 1985)
• Significant prolonged survival in patients with
  body cell mass 30 of body weight or serum
  albumin levels exceeding 3.0g/dl (Suttman 1991)

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Body Habitus Changes

• Metabolic changes in HIV infection result in
• Increased resting energy expenditure
• Prompter use of amino acids to fuel energy needs
• Continued fat accumulation
• More adipose tissue compared to lean tissue
• Lack of preservation and restoration of lean
  tissue
• Weight loss (HIV-associated wasting syndrome)
• High triglyceride levels in blood

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Effects of Nutrition on HIV/AIDS Observational
Studies

• Findings
• Weight loss associated with HIV infection,
  disease progression, and mortality
• Some nutrient deficiencies (vitamins A, B12, and
  E, selenium and zinc) associated with HIV
  transmission, disease progression, and mortality
• Observational studies do not tell us whether
  these
• conditions caused or resulted from more rapid
• progression. Clinical trials are needed to show
  that
• improving nutrition can slow HIV disease
  progression
• and increase survival.

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Effects of Nutrition on HIV/AIDS Clinical Trials
(1)

• Interventions to increase energy and protein
  intake in HIV people may reduce vulnerability to
  weight loss and muscle wasting
• High-energy, high-protein drink counseling
  (Stack et al 1996)led to weight gain and
  maintenance in HIV with no symptoms
• Omega-3 fatty acids common in fish oils and seeds
  (Hellerstein et al 1999) led to weight gain in
  some AIDS patients
• Glutamineantioxidantscounseling (Shabert et al
  1999) led to weight gain and improved body cell
  mass in HIV who had begun to lose weight

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Effects of Nutrition on HIV/AIDS Clinical Trials
(2)

• Improvements in micronutrient intake and status
  may help strengthen the immune system, reduce
  consequences of oxidative stress, and lengthen
  survival
• Vitamin A (Tanzania, South Africa) improved
  immune status, reduced diarrhea and mortality in
  HIV children.
• Vitamin B12 (USA-men) improved CD4 cell counts in
  HIV men
• Vitamins E and C (Canada,Zambia) reduced
  oxidative stress and HIV viral load
• Multivitamins (A,B,C,E, folic acid) improved
  pregnancy related outcomes and immune status

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Effects of Nutrition on HIV/AIDS Clinical Trials
(3)

• Selenium and beta-carotene (France)increased
  antioxidant enzyme functions
• Zinc (Italy)reduced incidence of opportunistic
  infections, stabilized weight, improved CD4
  counts in adults with AIDS
• Iron-reversing anemia (USA) slowed HIV
  progression and improved survival

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Conclusions

• HIV affects nutrition in three overlapping ways
• Nutritional status affects HIV disease
  progression and mortality
• Improving nutritional status may improve some
  HIV-related outcomes
• Counseling and other interventions to prevent
  weight loss probably have their greatest impact
  early in the course of HIV infection
• Nutritional supplements, particularly antioxidant
  vitamins and minerals, may improve HIV-related
  outcomes, particularly in nutritionally
  vulnerable populations