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.


Available from: Patrick Webb, Oct 21, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about 'brain drain' of Africa's health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries' trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of 'task-shifting' in rich and poor countries' health-care systems alike offers one means of thinking about global equity in access to quality care.
    Health 03/2014; 18(6). DOI:10.1177/1363459314524803 · 2.10 Impact Factor
  • Source
    [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: We investigated the association between household food insecurity (HFI) and CD4% among 2-6 year old HIV+ outpatients (n=78) at the Botswana-Baylor Children's Clinical Center of Excellence in Gaborone, Botswana. HFI was assessed by a validated survey. CD4% data were abstracted from the medical record. We used multiple linear regression with CD4% (dependent variable), HFI (independent variable), and controlled for socio-demographic and clinical covariates. Multiple linear regression showed a significant main effect for HFI (beta=-0.6, 95% CI [-1.0, -0.1]) and child gender (beta=5.6, 95% CI [1.3, 9.8]). Alleviating food insecurity may improve pediatric HIV outcomes in Botswana and similar Sub-Saharan settings.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 05/2014; DOI:10.1097/QAI.0000000000000190 · 4.39 Impact Factor