Nutrition and HIV/AIDS: A Training Manual - Linkages Project

Anemia already affects half of all pregnant women in Africa and is common in HIVinfectedwomen. Anemia is a risk factor for pre-term delivery and low birth weight,and both of these conditions increase the risk of MTCT. However, it is important torecognize that there are many causes of anemia in HIV infection. A study ofmultivitamins plus iron and folic acid given during pregnancy to HIV-infectedmothers (Fawzi et al 2000) resulted in increased weight gain during pregnancy, lowerrisk of low birth weight, and pre-term delivery, and other positive related outcomes.Increased energy demands during lactation may also increase weight loss, a riskfactor for reduced survival in HIV infection. The HIV-infected lactating woman is atan increased risk for malnutrition and may be at an increased risk for mortality,although results are not substantiated.There has been very little study of the impact of breastfeeding on maternal HIVdisease progression. Two published studies that contain such evidence were notoriginally designed to address this issue. One study, in Kenya (Nduati 2001), foundthat HIV-infected mothers who breastfed were more likely to die in the 2 yearsfollowing delivery compared with mothers who did not breastfeed. A study in SouthAfrica (Coutsoudis et al 2001) found no increased morbidity or mortality in womenwho breastfed. According to WHO, there is no conclusive evidence to suggest thatHIV-1-infected women who breastfeed are at an increased risk of mortality. Moreresearch is required before changes in policy can be made against breastfeeding byHIV-infected mothers for maternal survival can be made.It is also not known whether maternal nutritional supplementation can improve thehealth and prolong the survival of HIV-infected mothers who breastfeed. This issue iscurrently under study in Zambia and MalawiThe pregnant or lactating adolescent (slide 15)A young maternal age (11-18 years) increases nutrient needs above the ordinarydemands of pregnancy. This is a result of the combined needs for adolescent growthand fetal growth and development (American Dietetic Association and Dietitians ofCanada 2000). For the HIV-infected pregnant or lactating adolescent, nutrientrequirements increase as a result of HIV infection. Thus the requirement for energy,protein, and other nutrients increases overall to ensure continued growth of the130