AIDS and Nutrition:

Scene-Setter

Suneetha Kadiyala

RENEWAL 3 Regional Workshop

12th March 2007

Why is nutrition important?

• Co-existence of malnutrition and AIDS • Nutrition plays an imp. role in all aspects of the disease

Risks HIV AIDS Impacts

Prevention Care & treatment Mitigation

Outline

• What is the role of nutrition in research and programming?

• What are the evidence gaps?• What is the role for RENEWAL?• Highlight the potential collaborations in R3

Nutrition and HIV transmission: Adult to Adult

• Micronutrient deficiencies have been associated with increased risk of HIV transmission in observational studies – Malnutrition may increase genital ulcers and HSV shedding– May increase HIV-shedding increasing infectivity

• Conflicting results even in observational studies

Evidence Gap• How does pre-existing malnutrition affect susceptibility to HIV and

HIV infectivity?

Nutrition and HIV transmission: MTCT

• Micronutrient supplementation lowered the risk of MTCT only through breast feeding among highly immuno-compromised women

Evidence Gap

• To what extent does adequate nutrition before pregnancy lower MTCT rates and improve pregnancy and birth outcomes among HIV positive women?

Nutrition and HIV Progression

• Predictive link between losses in weight, fat-free mass, and body cell mass, and fat mass and adverse clinical outcomes

• Conflicting results from micronutrient studies– No effect of MN supplem. on outcomes in Zambia– MN supplem. resulted in lower death rates in Thailand– The effect of a given micronutrient intervention will depend on

the background dietary status and intake in the study population.

• Most studies are from the developed countries

Nutrition and HIV Progression

Evidence gaps• Most studies to date have examined the effect of single and in

some cases multiple micronutrient status on disease progression.

– Does a balanced diet improve clinical outcomes among those living with HIV in a chronically food insecure context?

• Which food and nutrition security programs are effective in improving the dietary intake of those infected and affected by HIV?

• What is the relative impact of such interventions on delaying ART initiation?

• What are the best nutritional indicators for monitoring the clinical response of PLWH to such interventions?

Nutrition and ART

• Interactions between ARVs, food and nutrition can influence: – drug efficacy, toxicity, adherence to drug regimens– Metabolic complications and nutritional status

Evidence Gaps:

• To what extent does adequate nutrition (micro/macro) complement ART in disease progression?

• How does nutrition security affect ARV adherence?

• What is the impact of ARVs on nutritional status (metabolic complications, changes in body composition etc) among the food insecure? – And how does this affect their clinical outcomes ?

Household nutrition security and AIDS

• Convincing evidence on how adult ill-health & death affect HH food & nutrition security

Evidence Gaps:• What are the intra household food distribution and nutrition

outcomes (beyond children)?– Implications for high risk behaviors

• What is the impact of ART on food and nutrition security of other household members?

• To what extent do food and nutrition security interventions complement ART in improving dietary intake and nutrition status of other household members?

Operational Questions

• Food aid is the most common ‘food & nutrition’ related intervention– What long term options exist for ensuring and sustaining

nutrition security within affected households and communities?

• What are the feasible eligibility and exit guidelines for initiating and transitioning from nutrition support?– Developing valid, but generally applicable M&E indicators

• What is the cost-effectiveness of alternate nutrition interventions to PLWHs and their households – what are the implications for scaling up such interventions?

Potential Collaborations

• TASO• University of Illinois (Paul McNamara)• AMPATH• Kaunda Foundation• Project Concern International