Nutrition and HIV/AIDS: A Training Manual - Linkages Project
Nutrition and HIV/AIDS: A Training Manual - Linkages Project
Nutrition and HIV/AIDS: A Training Manual - Linkages Project
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Body Habitus ChangesMetabolic changes in <strong>HIV</strong> 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 <strong>and</strong> restoration of lean tissue• Weight loss (<strong>HIV</strong>-associated wasting syndrome)• High triglyceride levels in bloodEffects of <strong>Nutrition</strong> on<strong>HIV</strong>/<strong>AIDS</strong>: Observational StudiesFindings• Weight loss associated with <strong>HIV</strong> infection, diseaseprogression, <strong>and</strong> mortality• Some nutrient deficiencies (vitamins A, B 12 , <strong>and</strong> E,selenium <strong>and</strong> zinc) associated with <strong>HIV</strong>transmission, disease progression, <strong>and</strong> mortalityObservational studies do not tell us whether theseconditions caused or resulted from more rapidprogression. Clinical trials are needed to show thatimproving nutrition can slow <strong>HIV</strong> disease progression<strong>and</strong> increase survival.Effects of <strong>Nutrition</strong> on<strong>HIV</strong>/<strong>AIDS</strong>: Clinical Trials (1)Interventions to increase energy <strong>and</strong> protein intakein <strong>HIV</strong>+ people may reduce vulnerability to weightloss <strong>and</strong> muscle wasting− High-energy, high-protein drink + counseling (Stacket al 1996)led to weight gain <strong>and</strong> maintenance in<strong>HIV</strong>+ with no symptoms− Omega-3 fatty acids common in fish oils <strong>and</strong> seeds(Hellerstein et al 1999) led to weight gain in some<strong>AIDS</strong> patients− Glutamine+antioxidants+counseling (Shabert et al1999) led to weight gain <strong>and</strong> improved body cellmass in <strong>HIV</strong>+ who had begun to lose weightEffects of <strong>Nutrition</strong> on<strong>HIV</strong>/<strong>AIDS</strong>: Clinical Trials (2)Improvements in micronutrient intake <strong>and</strong> status mayhelp strengthen the immune system, reduceconsequences of oxidative stress, <strong>and</strong> lengthen survival− Vitamin A (Tanzania, South Africa) improved immunestatus, reduced diarrhea <strong>and</strong> mortality in <strong>HIV</strong>+ children.− Vitamin B 12 (USA-men) improved CD4 cell counts in <strong>HIV</strong>+men− Vitamins E <strong>and</strong> C (Canada,Zambia) reduced oxidativestress <strong>and</strong> <strong>HIV</strong> viral load− Multivitamins (A,B,C,E, folic acid) improved pregnancyrelated outcomes <strong>and</strong> immune statusEffects of <strong>Nutrition</strong> on<strong>HIV</strong>/<strong>AIDS</strong>: Clinical Trials (3)− Selenium <strong>and</strong> beta-carotene (France)increased antioxidant enzyme functions− Zinc (Italy)reduced incidence ofopportunistic infections, stabilized weight,improved CD4 counts in adults with <strong>AIDS</strong>− Iron-reversing anemia (USA) slowed <strong>HIV</strong>progression <strong>and</strong> improved survivalConclusions• <strong>HIV</strong> affects nutrition in three overlapping ways• <strong>Nutrition</strong>al status affects <strong>HIV</strong> disease progression <strong>and</strong>mortality• Improving nutritional status may improve some <strong>HIV</strong>relatedoutcomes• Counseling <strong>and</strong> other interventions to prevent weightloss probably have their greatest impact early in thecourse of <strong>HIV</strong> infection• <strong>Nutrition</strong>al supplements, particularly antioxidantvitamins <strong>and</strong> minerals, may improve <strong>HIV</strong>-relatedoutcomes, particularly in nutritionally vulnerablepopulations
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