HIV/AIDS, undernutrition and food insecurity

Partners In Health, Boston, MA, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 10/2009; 49(7):1096-102. DOI: 10.1086/605573
Source: PubMed


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.

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Available from: Patrick Webb, Oct 21, 2014
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    • "Several studies reported a close association between malnutrition and impaired wound healing, increased postoperative complications, and mortality [20] [21] [22] [23] [24] [25]. Furthermore, malnutrition is common in various chronic diseases such as cancer, infections, chronic kidney diseases, and chronic heart failure [26] [27] [28] [29] [30]. A close relationship has been described between hospital length of stay and nutritional status: The longer the hospital stay, the greater the chance for undernutrition. "
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    ABSTRACT: Nutritional factors such as magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, polyunsaturated fatty acids (PUFAs) and adequate intake of protein to maintain normal concentrations of plasma albumin are of benefit for patients with coronary heart disease, and heart failure. These nutritional factors (magnesium, folic acid, vitamin B12, vitamin B6, L-arginine, and PUFAs) interact with the metabolism of L-arginine-nitric oxide system, essential fatty acids and eicosanoids to enhance the production of beneficial molecules such as nitric oxide, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins and protectins and suppress the production of harmful pro-inflammatory cytokines. Formation of adequate amounts of nitric oxide, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins and protectins are essential to prevent platelet aggregation, vasoconstriction and induce angiogenesis to prevent coronary heart disease and heart failure. These evidences suggest that adequate intake of these nutrients is necessary for subjects at high risk of coronary heart disease and heart failure so that they are protected against these diseases. In addition, screening 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 may help to detect subjects at high risk of coronary heart disease and heart failure and correcting their abnormalities could restore normal physiology.
    Full-text · Article · Mar 2015 · Agro Food Industry Hi Tech
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    • "Therefore, poor families with no or small farmlands, or HIV-positive people who are not strong enough to do the manual labor required on a farm, may have less food for their households. This in turn may lead to a chronic shortage of food and may bring about low dietary diversity and inadequate intake of nutrients [10], [11]. "
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    ABSTRACT: Methods: We conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32 care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and qualitative data through seven focus group discussions (FGDs). Results: HIV-positive children had high magnitudes of undernutrition. Stunting, underweight, wasting, and thinness were prevalent among 61.9%, 38.7%, 26.0%, and 21.1% of HIV-positive children, respectively. They also had poor feeding practices: 88.1% were fed at a frequency below the recommendations, and 62.3% had a low level of dietary diversity. Lower feeding frequency was associated with stunting (β = 0.11, p = 0.016); underweight (β = 0.12, p = 0.029); and thinness (β = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (β = 0.06, p<0.001), food insecurity (β = -0.05, p<0.001), and caregiver's education. In the FGDs, participants discussed the causal relationships among the key associations; undernutrition was mainly due to low feeding frequency and dietary diversity. Such poor feeding practices resulted from poor nutrition knowledge, food insecurity, low income, and poverty. Conclusion: Feeding practices and nutrition status were poor among HIV-positive children even in food rich areas. Improving feeding frequency may help to ameliorate undernutrition. To improve it, tailored interventions should target children of poor households, the food insecure, and caregivers who have received only a low level of education.
    Full-text · Article · May 2014 · PLoS ONE
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    • "Food insecurity, undernutrition, and human immunodeficiency virus (HIV) infection are structurally linked and often geographically overlapping problems that have negative impacts on individuals as well as on their households[1,2]. As HIV infection progresses, it causes a catabolic state and increased susceptibility to other infections, which are both compounded by lack of caloric and other nutrient intake, leading to progressive worsening of malnutrition[3]. In persons with HIV infection, low body mass index (BMI) is associated with increased early mortality[4], and food insecurity is associated with reduced adherence to antiretroviral therapy (ART) and incomplete viral RNA suppression[5,6]. "
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    ABSTRACT: Background: The epidemics of food insecurity, malnutrition, and human immunodeficiency virus (HIV) frequently overlap. HIV treatment programs increasingly provide nutrient-dense ready-to-use supplementary foods (RUSFs) to patients living with HIV and food insecurity, but in the absence of wasting, it is not known if RUSF confers benefit above less costly food commodities. Methods: We performed a randomized trial in rural Haiti comparing an RUSF with less costly corn-soy blend plus (CSB+) as a monthly supplement to patients with HIV infection who were on antiretroviral therapy (ART) <24 months prior to study start. We compared 6- and 12-month outcomes by ration type in terms of immunologic response, body mass index (BMI), adherence to ART, general health quality of life, household food insecurity, and household wealth. Results: A cohort of 524 patients with HIV receiving ART was randomized and followed over time. Median CD4 cell count at baseline was 339 cells/µL (interquartile range [IQR], 197-475 cells/µL) for the CSB+ group, and 341 cells/µL (IQR, 213-464/µL) for the RUSF group. Measured outcomes improved from baseline over time, but there were no statistically significant differences in change for BMI, household wealth index, hunger, general health perception score, or adherence to ART by ration type at 6 or 12 months. The RUSF group had higher CD4 count at 12 months, but this was also not statistically significant. Conclusions: In 12 months of follow-up, there was no statistically significant difference in outcomes between those receiving RUSF-based compared with CSB+-based rations in a cohort of HIV-infected adults on ART in rural Haiti.
    Full-text · Article · Feb 2014 · Clinical Infectious Diseases
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