HIV and nutrition: recommendations for nutritional care and support

Summary of a review¹

HIV/AIDS and malnutrition are inextricably interrelated. Research suggests that malnutrition increases the risk of HIV transmission from mothers to babies and the progression of HIV infection. In turn, HIV infection exacerbates malnutrition through its attack on the immune system and its impact on nutrient intake, absorption, and utilisation. This recently published review does not deal with emergency situations, however the findings clearly have relevance for emergency settings and the types of intervention mounted during emergencies.

Three overlapping process that lead to weight loss and wasting in people living with HIV/AIDS (PLWHA) are described, namely: reductions in food intake, nutrient malabsorption, and metabolic alterations. Several vitamins and minerals are critical for fighting HIV because they are required by the immune system and major organs to fight infectious pathogens. This document explores what is known about possible effects of these nutrients on HIV disease progression, mortality and on mother-to-child transmission (MTCT) of HIV.

The paper looks at research which indicates that in the early period of HIV infection, weight gain and/or body weight maintenance might be achieved. It addresses the extent to which nutrition counselling and interventions can slow or reverse the process, and subsequent consequences of weight loss and wasting in PLWHA. A number of examples of nutrition support programmes are presented, ranging from offering nutrition guidelines and dietary advice, to offering palliative and home based care and the provision of foods that are being offered to PLWHA in Africa.

aimed at increasing energy and protein intakes of people living with HIV may help to build body reserves and reduce a persons vulnerability to weight loss and wasting (direct consequences of diarrhoea and other opportunistic infections). Improvements in micronutrient intake and status may also help strengthen the immune system and reduce the adverse effect of infection related oxidative stress while lengthening survival time. Both interventions may help people living with HIV to remain relatively healthy, prolonging the interval from initial infection to development of AIDS and improve their quality of life. At later stages of the disease, nutrition support is largely palliative and focused on the dietary management of conditions that affect appetite, digestion and comfort when eating. These interventions are focused primarily on maintaining intake during bouts of illness and recuperative feeding when acute symptoms subside.

The complexities of weighing the competing risks of HIV transmission through breastfeeding with the various risks of replacement feeding are also explored. Recent research on HIV and breastfeeding is reviewed, and recommendations for safer breastfeeding are made. The authors conclude with recommendations for further research in the fields of nutritional management of HIV/AIDS and strategies to reduce the risk of mother-to-child transmission of HIV.

For more information contact: Support for Analysis and Research in Africa Project Academy for Educational Development 1825 Connecticut Avenue NW, Washington DC 200009 Telephone 1-202 884 8000 Fax 1-202 884 8400 E-mail: sara@aed.org

¹HIV/AIDS AND NUTRITION: A Review of the Literature and Recommendations for Nutritional Care and Support in Sub- Saharan Africa. Piwoz.E and Preble.E November 2000