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The role of nutrition in HIV infectionBy Marianne E.Visser
Nutrition and Dietetics Unit, University of Cape Town, South Africa
Severe weight loss occurs in many people with HIV infection and is closely associated with disease progression. Wasting and chronic diarrhoea are late stage manifestations of HIV disease in Central Africa and is thought to be caused mainly by gastrointestinal parasitic infections. However, other chronic opportunistic infections, particularly tuberculosis may also be important. Such wasting undoubtedly contributes to fatigue, lethargy and reduced exercise tolerance.
Malnutrition in HIV infection and AIDS
Despite the above, many individuals with HIV infection experience periods of weight stability. Episodes of weight gain are also common during the course of the disease, particularly after treatment of secondary infections. Nutritional supplementation has been shown to increase body weight, and specifically muscle mass only in the absence of systemic infections. What nutritional advice should we give?
During the course of HIV disease each individual should be weighed at every clinic visit, the pattern of weight change should be reviewed and underlying illnesses identified. During the asymptomatic period, nutrition education should promote a nutritionally balanced diet with the emphasis on locally available energy and protein rich foods and on correct cooking methods to minimise nutrient losses. Food hygiene is important in HIV-positive individuals with poor immune function as they are at an increased risk of food poisoning. Special care should be taken with uncooked products such as eggs, fish, meat and milk products (Table 1).TABLE 1: Food Safety Precautions
The efficacy of most alternative diet therapies eg. anti-candida diet, macrobiotic diet, amino acid compounds, herbal mixtures, etc. have not been subjected to formal clinical research and is the subject of much debate. Many of these therapies involve food restrictions resulting in a low caloric intake.
Several vitamin and mineral deficiencies are known to affect immune function and have been reported in HIV disease (Table 2).TABLE 2: Micronutrient deficiencies associated with a decreased immune response
Unfortunately there are no clinical data indicating the benefits and/or hazards of supplementing these nutrients at large doses. There is concern that megadoses may have negative effects on the immune system (Table 3).TABLE 3: Excessive micronutrient intakes associated with a decreased immune response
It seems prudent for all HIV infected individuals to consume an adequate vitamin intake from food, but in those with a poor dietary intake, a multivitamin and mineral supplement should be used.
Advice on symptom control
It is believed that early nutritional therapy in HIV disease result in a delayed immunological deterioration, fewer opportunistic infections and an improved quality of life.However, controlled trials are needed to define the optimal nutrition support and requirements of HIV infected individuals.
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