Nutritional challenges of HIV/AIDS

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People living with HIV/AIDS face increased challenges in maintaining proper nutrition. Despite developments in medical treatment, nutrition remains a key component in managing this condition. The challenges that those living with HIV/AIDS face can be the result of the viral infection itself or from the effects of anti-HIV therapy (HAART). [1]

Contents

Some of the side effects from HAART that may affect how the body absorbs and utilizes nutrients include fatigue, nausea, and poor appetite. [2] The nutritional needs of people with HIV/AIDS are also greater due to their immune system fighting off opportunistic infections that do not normally cause disease in people with healthy immune systems. [3] Medication along with proper nutrition is a major component of maintaining good health and quality of life for people living with HIV/AIDS.

HIV/AIDS and nutritional needs

Energy requirements

Monitoring caloric intake is important in ensuring that energy needs are met. For people with HIV/AIDS, energy requirements often increase in order to maintain their regular body weight. [4] A classification system revised by the Centers for Disease Control and Prevention (CDC), categorizes HIV-infection into three clinical stages and addresses the suggested caloric requirements for each stage. [5]

1. Clinical Category A: Asymptomatic HIV
This stage is characterized by Acute HIV. People in this category have estimated needs of 30-35 kcals/kg.
2. Clinical Category B: Symptomatic HIV
This stage is characterized by complications that arise from HIV symptoms. People in this category have estimated needs of 35-40 kcals/kg.
3. Clinical Category C: Presence of AIDS condition
This stage is characterized by having a T-cell count under 200, signaling the presence of an AIDS defining condition and/or an opportunistic infection. People in this category have estimated needs of 40–50 kcals/kg and are at an increased risk of malnourishment.[ citation needed ]

Micronutrient requirements

Multivitamins and supplementation

The World Health Organization (WHO) issued consultative recommendations regarding nutrient requirements in HIV/AIDS. [6] A generally healthy diet was promoted. For HIV-infected adults, the WHO recommended micronutrient intake comes from a good diet at RDA levels; higher intake of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults, and these were not recommended unless there is documented deficiency. [6] [7] [8] [9]

Despite the WHO recommendations, recent reviews have highlighted the absence of a simple consensus regarding the effects of multivitamins or micronutrient and nutrient supplementation on HIV positive individuals. This is partly due to a lack of strong scientific evidence. [8] [9] [10]

Some studies have looked into the use of implementing daily multivitamins into the diet regimens of HIV/AIDS patients. One study done in Tanzania involved a trial group with one thousand HIV positive pregnant women. Findings showed that daily multivitamins benefited both the mothers and their babies. After four years, the multivitamins were found to reduce the women's risk of AIDS and death by approximately 30%. [11] Another trial in Thailand revealed that the use of multivitamins led to fewer deaths, but only among people in advanced stages of HIV. [12] However, not all studies have provided a positive correlation. A small trial done in Zambia found no benefits from multivitamins after one month of use. [13]

Regarding individual vitamin and mineral supplementation, research shows mixed results. Vitamin A supplementation has been shown to reduce mortality and morbidity rates among African children with HIV. The WHO recommends vitamin A supplements for all young children 6 to 59 months old that are at high risk of vitamin A deficiency every 4 to 6 months. [14] In contrast, a trial from Tanzania found that the use of vitamin A supplements increased the risk of mother-to-child transmission by 40%. [15] [16] With the inconsistency of these results, scientists have not reached a consensus regarding vitamin A supplementation and its possible benefits for HIV/AIDS patients. Other vitamins to be taken by HIV-infected adults are vitamins C and E.[ citation needed ]

Evidence for supplementation with selenium is mixed with some tentative evidence of benefit. [17] There is some evidence that vitamin A supplementation in children reduces mortality and improves growth. [18] For nutritionally compromised pregnant and lactating women, a multivitamin supplementation has improved outcomes for both mothers and children. [19]

Thus, further research is required to determine the relationship between supplements and HIV/AIDS in order to develop effective nutritional interventions.[ citation needed ].

Effects of HIV/AIDS on nutrition

Statistics show that HIV/AIDS is most prevalent in the Sub-Saharan African region. [20] And according to the hunger map of 2010, [21] undernourishment is most prevalent in Asia-Pacific and, once again, in Sub-Saharan Africa. Some of the reasons as to why there is a correlation between malnutrition and the presence of HIV/AIDS are listed below.[ citation needed ]

Food security

Food security is present "when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life", as defined by the World Food Summit of 1996. It is set on the basis of food availability, food access, and proper food use. [22] The difficulty for some people with HIV and AIDS involves how they must obtain food security because the virus increases fatigue, compromising their ability to work in order to provide food and food preparation. This impact is even greater on those living in poverty in rural areas, where providing food is largely based on farming and other household chores. [23]

Case study in Malawi

In Malawi, the AIDS epidemic and its effect on food security for 65 rural households was studied. Findings revealed that illness and death as a result of AIDS compromised household food security. 24 out of 65 households had negative food security indexes, meaning that they did not have enough flour and/or corn to meet their daily caloric requirements. Sharing of food and resources was substantially decreased to those families that were affected with HIV/AIDS, which proved especially detrimental in families that no longer had a prime adult. With the removal of a prime adult, these families were deprived of productive labor resulting in serious production deficiencies. The study concludes that family members victimized by AIDS led to fracturing of interpersonal ties with other families which created food insecurity in a community based on a rural subsistence economy. [24]

Malnutrition

Child suffering from malnutrition Malnourished child.jpg
Child suffering from malnutrition

Malnutrition can be used as a measure of food insecurity and it has the most impact on those living in Sub-Saharan Africa and Asia-Pacific, where poverty and malnutrition is most prevalent in the world. [26] It is also in Sub-Saharan Africa where the cases of HIV/AIDS is most prevalent. [20] An individual whose body is already compromised with HIV has an immune system even less effective at defending against infections when the body is malnourished. Anti-retroviral drugs are now being distributed to people in these areas but when given to those who are undernourished, the medicine's effectiveness is decreased and toxicity is increased. Malnutrition accelerates the onset of the disease and give rise to repeated illnesses because of their weakened immune systems. Consequently, HIV and malnutrition provide a cyclic form of feedback for each other, with worsening conditions of malnutrition being linked to a more rapid onset of HIV. [27]

Food safety

For other uses, see food safety

People living with AIDS have impaired immune systems and therefore are more susceptible to infections and diseases due to foodborne pathogens. Food safety includes food handling, food preparation and food storage, all to be dealt with carefully to ensure safety from food-borne bacteria. Those that are more prevalent in people with AIDS include Salmonella , which is the most common cause of illness, being 100 times more prevalent in AIDS patients than healthy individuals. [28] Another example is listeriosis caused by Listeria monocytogenes , with severe and often fatal consequences when encountered by a person with AIDS. Simple measures can be used to increase food safety and prevent food-borne illnesses for those with affected with HIV/AIDS. Washing your hands, the food about to be prepared, kitchen utensils and kitchen surfaces is effective against bacterial growth. Keeping raw meat and cooked meat separate and cooking foods thoroughly, using a food thermometer to be sure. And lastly, storing leftover foods in the refrigerator within two hours to ensure minimal risk of food-borne illnesses. [29]

Research

There are some areas of research that have either not been explored or researched in-depth that are related to the area of HIV/AIDS treatment.

Food sustainability and agriculture

With food security also having an impact in rural areas affected by HIV/AIDS, another area of research involves agriculture in subsistence economies. More specifically, in these areas where households affected by HIV/AIDS may suffer from food insecurity, focuses for future research may include looking into ways to improve agricultural practices in order to enhance the household food production of families where one or more adults have HIV/AIDS. [30]

Related Research Articles

<span class="mw-page-title-main">Human nutrition</span> Nutrients supporting human health

Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. Poor nutrition is a chronic problem often linked to poverty, food security, or a poor understanding of nutritional requirements. Malnutrition and its consequences are large contributors to deaths, physical deformities, and disabilities worldwide. Good nutrition is necessary for children to grow physically and mentally, and for normal human biological development.

<span class="mw-page-title-main">Food security</span> Measure of the availability and accessibility of food

Food security is the state of having reliable access to a sufficient quantity of affordable, nutritious food. The availability of food for people of any class and state, gender or religion is another element of food security. Similarly, household food security is considered to exist when all the members of a family, at all times, have access to enough food for an active, healthy life. Individuals who are food-secure do not live in hunger or fear of starvation. Food security includes resilience to future disruptions of food supply. Such a disruption could occur due to various risk factors such as droughts and floods, shipping disruptions, fuel shortages, economic instability, and wars. Food insecurity is the opposite of food security: a state where there is only limited or uncertain availability of suitable food.

<span class="mw-page-title-main">Malnutrition</span> Medical condition caused by receiving too little or too many nutrients

Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues and form.

Orthomolecular medicine is a form of alternative medicine that claims to maintain human health through nutritional supplementation. It is rejected by evidence-based medicine. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence, and the therapy is not effective for chronic disease prevention; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

<span class="mw-page-title-main">Marasmus</span> Medical condition

Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein. This clear-cut separation of marasmus and kwashiorkor is however not always clinically evident as kwashiorkor is often seen in a context of insufficient caloric intake, and mixed clinical pictures, called marasmic kwashiorkor, are possible. Protein wasting in kwashiorkor generally leads to edema and ascites, while muscular wasting and loss of subcutaneous fat are the main clinical signs of marasmus, which makes the ribs and joints protrude.

<span class="mw-page-title-main">Multivitamin</span> Dietary supplement containing vitamins

A multivitamin is a preparation intended to serve as a dietary supplement with vitamins, dietary minerals, and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids, or injectable formulations. Other than injectable formulations, which are only available and administered under medical supervision, multivitamins are recognized by the Codex Alimentarius Commission as a category of food.

Micronutrients are essential dietary elements required by organisms in varying quantities to regulate physiological functions of cells and organs. Micronutrients support the health of organisms throughout life.

Matthias Rath is a doctor, businessman, and vitamin salesman. He earned his medical degree in Germany. Rath claims that a program of nutritional supplements, including formulations that he sells, can treat or cure diabetes, cardiovascular disease, cancer, and HIV/AIDS. These claims are not supported by any reliable medical research. Rath runs the Dr. Rath Health Foundation, has been closely associated with Health Now, Inc., and founded the Dr. Rath Research Institute.

Food fortification or enrichment is the process of adding micronutrients to food. It can be carried out by food manufacturers, or by governments as a public health policy which aims to reduce the number of people with dietary deficiencies within a population. The predominant diet within a region can lack particular nutrients due to the local soil or from inherent deficiencies within the staple foods; the addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases.

Diseases of poverty, also known as poverty-related diseases, are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.

<span class="mw-page-title-main">Vitamin A deficiency</span> Disease resulting from low Vitamin A concentrations in the body

Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Nyctalopia is one of the first signs of VAD, as the vitamin has a major role in phototransduction; but it is also the first symptom that is reversed when vitamin A is consumed again. Xerophthalmia, keratomalacia, and complete blindness can follow if the deficiency is more severe.

<span class="mw-page-title-main">Micronutrient deficiency</span> Medical condition

Micronutrient deficiency is defined as the sustained insufficient supply of vitamins and minerals needed for growth and development, as well as to maintain optimal health. Since some of these compounds are considered essentials, micronutrient deficiencies are often the result of an inadequate intake. However, it can also be associated to poor intestinal absorption, presence of certain chronic illnesses and elevated requirements.

<span class="mw-page-title-main">Biofortification</span> Breeding crops for higher nutritional value

Biofortification is the idea of breeding crops to increase their nutritional value. This can be done either through conventional selective breeding, or through genetic engineering. Biofortification differs from ordinary fortification because it focuses on making plant foods more nutritious as the plants are growing, rather than having nutrients added to the foods when they are being processed. This is an important improvement on ordinary fortification when it comes to providing nutrients for the rural poor, who rarely have access to commercially fortified foods. As such, biofortification is seen as an upcoming strategy for dealing with deficiencies of micronutrients in low and middle-income countries. In the case of iron, the WHO estimated that biofortification could help cure the 2 billion people suffering from iron deficiency-induced anemia.

Anemia is a deficiency in the size or number of red blood cells or in the amount of hemoglobin they contain. This deficiency limits the exchange of O2 and CO2 between the blood and the tissue cells. Globally, young children, women, and older adults are at the highest risk of developing anemia. Anemia can be classified based on different parameters, and one classification depends on whether it is related to nutrition or not so there are two types: nutritional anemia and non-nutritional anemia. Nutritional anemia refers to anemia that can be directly attributed to nutritional disorders or deficiencies. Examples include Iron deficiency anemia and pernicious anemia. It is often discussed in a pediatric context.

<span class="mw-page-title-main">HIV-affected community</span> Medical condition

The affected community is composed of people who are living with HIV and AIDS, plus individuals whose lives are directly influenced by HIV infection. This originally was defined as young to middle aged adults who associate with being gay or bisexual men, and or injection drug users. HIV-affected community is a community that is affected directly or indirectly affected by HIV. These communities are usually influenced by HIV and undertake risky behaviours that lead to a higher chance of HIV infection. To date HIV infection is still one of the leading cause of deaths around the world with an estimate of 36.8 million people diagnosed with HIV by the end of 2017, but there can particular communities that are more vulnerable to HIV infection, these communities include certain races, gender, minorities, and disadvantaged communities. One of the most common communities at risk is the gay community as it is commonly transmitted through unsafe sex. The main factor that contributes to HIV infection within the gay/bisexual community is that gay men do not use protection when performing anal sex or other sexual activities which can lead to a higher risk of HIV infections. Another community will be people diagnosed with mental health issues, such as depression is one of the most common related mental illnesses associated with HIV infection. HIV testing is an essential role in reducing HIV infection within communities as it can lead to prevention and treatment of HIV infections but also helps with early diagnosis of HIV. Educating young people in a community with the knowledge of HIV prevention will be able to help decrease the prevalence within the community. As education is an important source for development in many areas. Research has shown that people more at risk for HIV are part of disenfranchised and inner city populations as drug use and sexually transmitted diseases(STDs) are more prevalent. People with mental illnesses that inhibit making decisions or overlook sexual tendencies are especially at risk for contracting HIV.

<span class="mw-page-title-main">Health in Mozambique</span>

Health in Mozambique has a complex history, influenced by the social, economic, and political changes that the country has experienced. Before the Mozambican Civil War, healthcare was heavily influenced by the Portuguese. After the civil war, the conflict affected the country's health status and ability to provide services to its people, breeding the host of health challenges the country faces in present day.

Malnutrition continues to be a problem in the Republic of South Africa, although it is not as common as in other countries of Sub-Saharan Africa.

<span class="mw-page-title-main">Environmental enteropathy</span> Disorder of chronic intestinal inflammation

Environmental enteropathy is an acquired small intestinal disorder characterized by gut inflammation, reduced absorptive surface area in small intestine, and disruption of intestinal barrier function. EE is most common amongst children living in low-resource settings. Acute symptoms are typically minimal or absent. EE can lead to malnutrition, anemia, stunted growth, impaired brain development, and impaired response to oral vaccinations.

<span class="mw-page-title-main">Undernutrition in children</span> Medical condition affecting children

Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.

<span class="mw-page-title-main">Child health and nutrition in Africa</span>

Child health and nutrition in Africa is concerned with the health care of children through adolescents in the various countries of Africa. The right to health and a nutritious and sufficient diet are internationally recognized human rights that are protected by international treaties. Millennium Development Goals (MDGs) 1, 4, 5 and 6 highlight, respectively, how poverty, hunger, child mortality, maternal health, the eradication of HIV/AIDS, malaria, tuberculosis and other diseases are of particular significance in the context of child health.

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