Nutrition and HIV

Epidemiological Evidence to Public Health

Saurabh Mehta, Julia Finkelstein

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781351058179
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

The world continues to lose more than a million lives each year to the HIV epidemic, and nearly two million individuals were infected with HIV in 2017 alone. The new Sustainable Development Goals, adopted by countries of the United Nations in September 2015, include a commitment to end the AIDS epidemic by 2030. Considerable emphasis on prevention of new infections and treatment of those living with HIV will be needed to make this goal achievable. With nearly 37 million people now living with HIV, it is a communicable disease that behaves like a noncommunicable disease.

Nutritional management is integral to comprehensive HIV care and treatment. Improved nutritional status and weight gain can increase recovery and strength of individuals living with HIV/AIDS, improve dietary diversity and caloric intake, and improve quality of life. This book highlights evidence-based research linking nutrition and HIV and identifies research gaps to inform the development of guidelines and policies for the United Nations' Sustainable Development Goals.

A comprehensive approach that includes nutritional interventions is likely to maximize the benefit of antiretroviral therapy in preventing HIV disease progression and other adverse outcomes in HIV-infected men and women. Modification of nutritional status has been shown to enhance the quality of life of those suffering HIV/AIDS, both physically in terms of improved body mass index and immunological markers, and psychologically, by improving symptoms of depression. While the primary focus for those infected should remain on antiretroviral treatment and increasing its availability and coverage, improvement of nutritional status plays a complementary role in the management of HIV infection.

Contents

List of Figures

List of Tables

Foreword

Preface

About the Editors

About the Contributors

Abbreviations

Chapter 1 Human Immunodeficiency Virus and Vitamin A

Samantha L. Huey and Saurabh Mehta

Chapter 2 B-Vitamins and HIV/AIDS

Alexander J. Layden and Julia L. Finkelstein

Chapter 3 Iron and HIV/AIDS

Nabila R. Khondakar and Julia L. Finkelstein

Chapter 4 Vitamin D and HIV

Elaine A. Yu and Saurabh Mehta

Chapter 5 Antioxidants and HIV/AIDS: Zinc, Selenium, and Vitamins C and E

Amanda L. Wilkinson, Samantha L. Huey, and Saurabh Mehta

Chapter 6 Micronutrients and Perinatal Outcomes in HIV-Infected Pregnant Women

Julia L. Finkelstein and Saurabh Mehta

Chapter 7 HIV and Infant Feeding

Ameena Goga and Anna Coutsoudis

Chapter 8 Micronutrients and HIV in Pediatric Populations

Julia L. Finkelstein, Haritha Aribindi, Heather S. Herman, and Saurabh Mehta

Chapter 9 Macronutrient Supplementation to HIV and TB Patients during Treatment

Henrik Friis, Mette Frahm Olsen, and Suzanne Filteau

Index

List of Figures

Figure 1.1 Study selection

Figure 2.1 Diagrammatic representation of the search strategy used to identify and select studies for inclusion in the review.

Figure 3.1 Search strategy (search date closed November 18, 2015; last updated July 11, 2016). Randomized controlled trials (RCTs) are RCTs with intervention as iron and RCTs with intervention as HAART or HAART/ iron

Figure 4.1 Study selection

Figure 5.1 Study selection

Figure 6.1 Study selection

Figure 7.1 Example of an algorithm used to apply the AFASS Criteria in South Africa

Figure 7.2 Dilemma faced by public health.

Figure 8.1 Study selection

Figure 9.1 Weight changes over a 12-month period, according to sex of patients and place of treatment

List of Tables

Table 1.1 Laboratory and Animal Studies

Table 1.2 Observational Studies

Table 1.3 Randomized Controlled Trials

Table 1.4 Vitamin A and ART/HAART

Table 2.1 Summary of Multivitamin Trials

Table 2.2 Randomized Trials of Multiple Micronutrient Interventions

Table 2.3 Randomized Trials of Single Micronutrient Interventions

Table 3.1 Randomized Controlled Trials

Table 3.2 Intervention Studies

Table 3.3 Cohort Studies

Table 3.4 Case-Control Studies

Table 3.5 Cross-Sectional Studies

Table 4.1 Vitamin D and HIV Disease Progression among Individuals Living with HIV

Table 4.2 Vitamin D Supplementation among Individuals Living with (or Exposed to) HIV/AIDS in Intervention Studiesa

Table 4.3 Effects of ART on Vitamin D Status among Individuals Living with HIV/AIDS in Randomized Controlled Trials

Table 5.1 Trials of Zinc Supplementation in Adults and Children with HIV Infection

Table 5.2 Trials of Selenium Supplementation in Adults and Children with HIV Infection

Table 5.3 Trials of Vitamin C and/or E Supplementation in Adults and Children with HIV Infection

Table 6.1 Randomized Trials

Table 7.1 Summary of WHO PMTCT Guidelines: 2000 to Date

Table 7.2 Estimated Timing and Risk of Mother-to-Child Human Immunodeficiency Type 1 Transmission without Antiretroviral Interventions and with Minimal Antiretroviral Prophylaxis

Table 7.3 Percentage Decline in New HIV Infections among Children from 2009 to 2015 in 20 Global Plan Priority Countries

Table 7.4 Population Attributable Fractions for Late Postnatal Transmission in Sub-Saharan Africa

Table 7.5 Immunologic Properties in Breast Milk and Infant Responses to HIV Exposure May Protect Against MTCT

Table 7.6 Breast Milk HIV Transmission When No Antiretroviral Interventions Were Available

Table 7.7 HIV Transmission through Breastfeeding with Minimal ARV Interventions

Table 7.8 HIV Transmission through Breastfeeding in the Era of Maternal or Infant ARV Prophylaxis/Treatment

Table 7.9 Immunotherapeutic (Vaccine) Trials Applicable to MTCT

Table 7.10 Support for Infant Feeding among HIV-Infected Women Based on the 2000 WHO Guidelines

Table 8.1 Micronutrient Supplementation in HIV-Infected and HIV-Exposed Children

Table 8.2 Micronutrient Supplementation in HIV-Infected and HIV-Uninfected Children

Table 8.3 Micronutrient Supplementation in HIV-Infected Children

Table 8.4 Micronutrient Supplementation in HIV-Infected Mothers and Their Children

Table 9.1 Potential General and Disease-Specific Effects of Nutritional Deficiencies

Foreword

Ron:

I thought AZT’s supposed to help me.

Dr. Vass:

The only people AZT helps are the people who sell it. (beat) It kills every cell it comes in contact with, good and bad.

Ron:

So medically speakin’, I kicked my own ass!

Dr. Vass:

(nods as he writes)

I’m prescribing a regimen of vitamins as well as the mineral zinc to build your immune system back up.

You’ll also be taking Aloe and essential fatty acids.

Dallas Buyers Club script

The above excerpt from the script for the 2013 American film Dallas Buyers Club is from a scene that touched me in both personal and professional ways. This encounter between Ron (Matthew McConaughey) and Dr. Vass (Griffin Dunne) represents a historical turning point in the role of nutrition in the management of the HIV epidemic. I have long reflected on the particular period reflected in the movie. There has been an unprecedented search to understand the impact that nutrition has on the health and wellbeing of individuals living with HIV/AIDS. The almost messianic merits of “alternative” approaches to HIV and AIDS prevention and treatment played an important role during one of the worst moments of the epidemic. We finally reached the point of acknowledging that fighting against HIV also entails dealing with lifestyle modifications. The various definitions of healthy lifestyles are vague, but equally uncertain are the nutritional recommendations regarding HIV and AIDS. Numerous research efforts have produced myriad results that appear to conflict with each other. The concept of evidence-based medicine gained visibility at about this same time. Given the existing scientific evidence and experience to date, it would be irresponsible to ignore the importance of nutrition in patient-centered care for those living with HIV.

I lived similar scenes of despair when I lost friends and family members to this disease. During my research at the Latin American Center for Sexually Transmitted Diseases in Puerto Rico, many patients poured through the clinic doors reporting allegedly efficacious nutrition interventions. Like Ron, the main character in Dallas Buyers Club, patients in many hos...

Table of contents

• Cover
• Halftitle Page
• Title Page
• Copyright
• Table of Contents