Article

HIV/AIDS, undernutrition, and food insecurity.

Partners In Health, Boston, MA, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 10/2009; 49(7):1096-102. DOI: 10.1086/605573
Source: PubMed

ABSTRACT Despite tremendous advances in care for human immunodeficiency virus (HIV) infection and increased funding for treatment, morbidity and mortality due to HIV/AIDS in developing countries remains unacceptably high. A major contributing factor is that >800 million people remain chronically undernourished globally, and the HIV epidemic largely overlaps with populations already experiencing low diet quality and quantity. Here, we present an updated review of the relationship between HIV infection, nutritional deficiencies, and food insecurity and consider efforts to interrupt this cycle at a programmatic level. As HIV infection progresses, it causes a catabolic state and increased susceptibility to other infections, which are compounded by a lack of caloric and other nutrient intake, leading to progressive worsening of malnutrition. Despite calls from national and international organizations to integrate HIV and nutritional programs, data are lacking on how such programs can be effectively implemented in resource-poor settings, on the optimum content and duration of nutritional support, and on ideal target recipients.

0 Followers
 · 
112 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nutritional factors such as magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, and polyunsaturated fatty acids (PUFAs) appear to be of significant benefit for patients with coronary heart disease, and in the prevention and arresting the progression of heart failure and cardiac arrhythmias. In addition, ingestion of adequate amount of protein and maintaining normal concentrations of plasma albumin seem to be essential for these patients. These nutrients closely interact with the metabolism of L-arginine-nitric oxide system, essential fatty acids and eicosanoids such that beneficial products such as nitric oxide, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins and protectins are generated and synthesis of pro-inflammatory cytokines is suppressed that results in platelet anti-aggregation, vasodilatation, angiogenesis and prevention of coronary heart disease, cardiac arrhythmias and stabilization of heart failure. This implies that subjects at high risk of coronary heart disease, cardiac arrhythmias and heart failure and those who have these diseases need to be screened for plasma levels of magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, nitric oxide, various PUFAs, lipoxin A4, resolvins, protectins, asymmetrical dimethylarginine (ADMA-an endogenous inhibitor of nitric oxide), albumin, and various eicosanoids and cytokines and correct their abnormalities to restore normal physiology.
    Nutrition 09/2014; 31(2). DOI:10.1016/j.nut.2014.08.011 · 3.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study examines the prevalence of food/housing insecurity and its association with psychological, behavioral, and environmental factors impacting antiretroviral (ARV) medication adherence and diversion among substance using HIV+ patients in South Florida. Five hundred and three HIV+ substance abusers were recruited through targeted sampling. Participants completed a standardized instrument assessing demographics, mental health status, sex risk behaviors, HIV diagnosis, treatment history and access, ARV adherence and diversion, and attitudes toward health-care providers. Chi-square and t-tests were used to examine differences by food/housing status and a multivariate linear regression model examined food/housing insecurity and its associations to ARV adherence. Food/housing insecurity was reported by 43.3% of the sample and was associated with higher likelihood of severe psychological distress and substance dependence. Nearly 60% reported recent ARV diversion; only 47.2% achieved 95% medication adherence over one week. Food/housing insecure participants had deficits in their HIV care, including less time in consistent care, lower access to medical care, and less favorable attitudes toward care providers. Multivariate linear regression showed food/housing insecurity demonstrated significant main effects on adherence, including lower past week adherence. Medication diversion was also associated with reduced adherence. Our findings suggest that food/housing insecurity operates as a significant driver of ARV non-adherence and diversion in this population. In the pursuit of better long-term health outcomes for vulnerable HIV+ individuals, it is essential for providers to understand the role of food and housing insecurity as a stressor that negatively impacts ARV adherence and treatment access, while also significantly contributing to higher levels of distress and substance dependence.
    AIDS Care 10/2014; 27(3):1-8. DOI:10.1080/09540121.2014.967656 · 1.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background HIV and negative coping mechanisms have a cyclical relationship. HIV infections may lead to the adoption of coping strategies, which may have undesired, negative consequences. We present data on the various coping mechanisms that HIV-affected households in Ghana resort to. Methods We collected data on coping strategies, livelihood activities, food consumption, and asset wealth from a nationally representative sample of 1,745 Ghanaian HIV-affected households. We computed coping strategies index (CSI), effective dependency rate, and asset wealth using previously validated methodologies. Results Various dehumanizing coping strategies instituted by the HIV-affected households included skipping an entire day’s meal (13%), reducing portion sizes (61.3%), harvesting immature crops (7.6%), and begging (5.6%). Two-thirds of the households were asset poor. Asset-poor households had higher CSI than asset-rich households (p <0.001). CSI were also higher among female-headed households and lower where the education level of the household head is higher. Households caring for chronically ill members recorded higher CSI in comparison with their counterparts without the chronically ill (p < 0.05). Conclusions Institution of degrading measures by HIV-affected households in reaction to threat of food insecurity was prevalent. The three most important coping strategies used by households were limiting portion size (61.3%), reducing number of meals per day (59.5%) and relying on less expensive foods (56.2%). The least employed strategies included household member going begging (5.6%), eating elsewhere (8.7%) and harvesting immature crop (7.6%). Given that household assets, and caring for the chronically ill were associated with high CSI, a policy focusing on helping HIV-affected households gradually build up their asset base, or targeting households caring for chronically ill member(s) with conditional household-level support may be reasonable.
    BMC Public Health 02/2015; 15(166). DOI:10.1186/s12889-015-1418-x · 2.32 Impact Factor

Full-text (2 Sources)

Download
13 Downloads
Available from
Oct 21, 2014