Background

Given the high underlying prevalence of malnutrition in many countries where the HIV epidemic is an important contributor to morbidity and mortality, the interaction between the disease and nutrition make this an important area of study. However, while a number of HIV-related nutrition interventions have been piloted and implemented, the benefits of such interventions have not been rigorously investigated. Furthermore, the majority of research to date has focused on developed countries. In the case of food aid/emergency responses and in agricultural and rural development in particular, best practice remains based largely on anecdotal evidence.

Studies have shown that the energy needs of HIV-infected individuals increase, even when showing no symptoms, and opportunistic infections (infections that take advantage of the weakening of the immune system caused by HIV) lead to higher protein and micronutrient utilisation. In addition, the acute phase response of HIV produces changes in levels of micronutrients and some associated proteins, which do not necessarily represent a deficiency in stores of these micronutrients. This makes it difficult to accurately assess the nutritional status of people living with HIV and AIDS (PLWHA).

Weight loss is a very strong predictor of mortality and in turn viral load a strong predictor of weight loss. Although ARVs can contribute to the maintenance of health and avoidance of weight loss [26], malnutrition and wasting are still common, even among HIV-infected patients on ARV treatment in developed countries. This may be due, in part, to the effect that chronic malnutrition will have some on absorption and utilisation of both foods and drugs. ARVs may also impact on the absorption and metabolism of foods and so influence nutritional status and body composition.

There is little research on the interactions between micronutrients and ARVs. Nevertheless, multiple micronutrient supplementation has been shown to have beneficial effects in a number of HIV related parameters, such as incidence of diarrhoea, progression to AIDS and mortality. Additionally, multivitamins have been shown to significantly improve child CD4 (a type of white blood cell. The decrease in number of CD4 cells is the primary mechanism by which HIV causes AIDS) counts over time. The data suggests that multivitamins may delay the onset of AIDS and extend the time before ARV therapy becomes necessary. The provision of multivitamins could be a cost-effective intervention, but the best formulation for different disease stages of multiple micronutrient supplementation still needs to be established.