Introduction to Human Nutrition

Food and Nutrition-Related Diseases 357

Malignant diseases and dementia may develop. This

is the fi nal stage, and if not treated by antiretroviral

drugs and specifi c drugs for the secondary infec-

tions it invariably leads to death.

Nutrition and HIV/AIDS

The role of nutrition in HIV/AIDS is complex. As
mentioned above, malnutrition could contribute to
increased vulnerability to infection in developing
countries. The virus probably increases nutritional
needs, while its effects on the nervous and digestive
system lead to decreased appetite and intakes,
impaired digestion, and malabsorption. The conse-
quent loss of lean body mass gave the infection its
original African name of “thin disease.” There are
indications that improved nutrition may slow the
progression of HIV infection to AIDS. There is evi-
dence that nutritional support can help in the toler-
ance of antiretroviral drugs and their side-effects and
assist in the management of some of the secondary
infections of AIDS.
The optimal diet for people living with HIV/AIDS
is not known. At least one study (the THUSA study
in South Africa) indicated that asymptomatic infected
subjects who regularly included animal-derived foods
in their diets had better health outcomes than those
on plant-based diets and with high omega-6 polyun-
saturated fat intakes. The nutritional recommenda-
tions for people living with HIV/AIDS are therefore
evidence informed and not totally evidence based at
this stage. Global recommendations have recently
been evaluated by the Academy of Science of South
Africa, and some of their conclusions are summarized
in Box 15.3.
The transmission of the virus and the different
stages in the progression of infection to AIDS indicate
that different levels of nutrition intervention and
support are needed, as illustrated in Box 15.4. Specifi c
nutrient requirements during HIV infection are
discussed in the clinical nutrition textbook of this
series.

15.5 The global challenge to address
malnutrition

Background

The nutritional problems and diseases facing mankind
at the beginning of the twenty-fi rst century have been

Box 15.3 Nutritional recommendations for HIV/AIDS

1 Nutrition recommendations should do no harm

2 Optimum nutrition at population level is necessary as part of a

set of general measures to reduce the spread of HIV and TB

3 The focus should be on diversifi ed diets including available,

affordable and traditional foods. However, fortifi ed foods as

well as macro- and micronutrient supplements at safe levels

(not more than twice daily recommended level) may be helpful

4 Ready-to-use therapeutic food supplements are effective in

reversing poor nutritional status found in severely affected indi-

viduals

5 Because micronutrient defi ciencies may hasten disease progres-

sion and facilitate mother-to-child transmission of HIV, multi-

vitamin, zinc and selenium supplementations are indicated, but

vitamin A supplementation may increase mother-to-child trans-

mission and zinc supplementation may be harmful in pregnant

women

6 HIV-infected pregnant women, lactating mothers and their

babies need special advice and care to ensure best possible

outcomes

7 Established, well-described steps and protocols should be fol-

lowed in public health nutrition interventions and in the thera-

peutical (medical) nutritional support of patients

General Principles from ASSAf (2007).

Box 15.4 Types of nutrition interventions needed

Stage Nutrition intervention needed

Poverty/malnutrition

cycle

Public Health Nutrition (PHN) pro-

grams as part of other programs to

alleviate poverty and improve

socioeconomic development

Increased vulnerability

Decreased

immunocompetence

Transmission

High risk behavior

Asymptomatic HIV

People living with HIV

(PLWH)

AIDS

Targeted nutrition (TN) programs

for vulnerable groups including

advice to pregnant mothers

TN programs for PLWH, including

food assistance; food-based dietary

guidelines plus advice on safe

foods and drinking water

Individual therapeutic or medical

nutrition (IMN) programs:

i Facility based IMN programs

with defi ned algorithms

ii Home-based care IMN programs

with practical advice

Food and supplement assistance