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HIV and HIV/TB Co-infection in Relation to Nutrition

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Nutrition and Health in a Developing World

Part of the book series: Nutrition and Health ((NH))

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Abstract

Malnutrition and HIV are inextricably linked, especially in resource-limited settings, and the combination is detrimental to disease outcomes. The malnutrition that is seen with HIV infections is complex and multifactorial, including metabolic derangements, leading to weight loss and wasting, which increases mortality risk, also among people starting anti-retroviral treatment. Malnutrition is even more common in HIV and TB co-infected individuals and found to be associated with severe adverse outcomes. Medical, socioeconomic, cultural, and psychological factors all play a role in the development of nutritional compromise with HIV or HIV/TB co-infection and vulnerable populations such as children, adolescents, pregnant women and the elderly, as well as poor and food-insecure people are at particular risk. While it is clear that treatment of the underlying HIV and/or TB is absolutely critical to improving outcomes, abnormal nutritional status persists despite (in case of ARV, lifelong) treatment and continues to contribute to adverse outcomes. Therefore, it is important to monitor nutritional status, including weight, and ensure adequate nutritional intake, which may require specific nutritious foods. According to WHO guidance, micronutrient intake should be at the level of one RNI, as with the evidence that is currently available, it is not possible to recommend other levels for either of these infections. In summary, because of the linkages between malnutrition and HIV and TB infection, as well as the nutrition issues related to long-term ART use and chronic HIV infection, it is important to continue to ensure nutrition assessment and counseling are part of standard care and treatment programs, and that these are augmented where necessary with support in the form of special nutritious foods and/or food assistance to support access, adherence, and retention in care and treatment.

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References

  1. Duggal S, Chugh TD, Duggal AK. HIV and malnutrition: effects on immune system. Clin Dev Immunol [internet]. 2012;1–8 [cited 2014 June]. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254022/.

  2. Hunger Statistics [internet]. [place unknown]: World Food Program; 2014 [cited 2014 June]. Available from http://www.wfp.org/hunger/stats.

  3. Koethe JR, Heimburger DC. Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr. 2010;91(suppl):1138S–42S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. HIV/AIDS Global Health Observatory [internet]. Geneva: World Health Organization; 2014 [cited 2014 June]. Available from http://www.who.int/gho/hiv/en/.

  5. Havens PL, Mofenson LM. American academy of pediatrics committee on pediatric AIDS. Evaluation and management of the infant exposed to HIV-1 in the United States. Pediatrics. 2009;123:175.

    Article  PubMed  Google Scholar 

  6. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children [internet]. Geneva: World Health Organization; 2007 [cited 2015 July]. Available from www.who.int/hiv/pub/guidelines/hivstaging150307.pdf.

  7. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection [internet]. Geneva: World Health Organization; 2013 [cited 2015 July]. Available from http://www.who.int/hiv/pub/guidelines/arv2013/download/en/.

  8. Faintuch J, Soeters PB, Osmo HG. Nutritional and metabolic abnormalities in pre-AIDS HIV infection. Nutriton. 2006;22(6):683–90.

    CAS  Google Scholar 

  9. Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy form the nutrition for healthy living cohort. Clin Infect Dis. 2006;15(42):836–42.

    Article  Google Scholar 

  10. Mwamburi M, Wilson IB, Jacobson DL, Spiegelman D, Gorbach SL, Knox TA, Wanke CA. Understanding the role of HIV load in determining weight change in the era of highly active antiretroviral therapy. Clin Infect Dis. 2004;15(40):167–73.

    Google Scholar 

  11. Ivers LC, Culle KA, Freedberg KA, Block S, Coates J, Webb P. HIV/AIDS, undernutrition, and food insecurity. Clin Infect Dis. 2009;1(49):1096–102.

    Article  Google Scholar 

  12. McMahon J, Wanke C, Terrin N, Skinner S, Knox T. Poverty, hunger, education and residential status impact survival in HIV. AIDS Behav. 2011;15(7):1503–11.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rawat R, McCoy SI, Kadiyala S. Poor diet quality is associated with low CD 4 count and anemia and predicts mortality among antiretroviral therapy-naïve HIV-positive adults in Uganda. J Acquir Immune Defic Syndr. 2013;1(62):246–53.

    Article  Google Scholar 

  14. Young S, Wheeler AC, McCoy SI, Weiser SD. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav [internet]. 2013:12 [cited June 2014]. Available from http://rd.springer.com/article/10.1007%2Fs10461-013-0547-4.pdf.

  15. Palermo T, Rawat R, Weiser SD, Kadiyala S. Food access and diet quality are associated with quality of life outcomes among HIV-infected individuals in Uganda. PLoS ONE [internet]. 2013;8(4):e62353 [cited 2014 June]. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630150.

  16. Kosmiski L. Energy expenditure in HIV infection. Am J Clin Nutr. 2011;94(suppl):1677S–82S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr. 1997;66:464S–77S.

    CAS  PubMed  Google Scholar 

  18. Nutrient requirements for people living with HIV/AIDS. Geneva, Switzerland. World Health Organization. 13–15 May 2003.

    Google Scholar 

  19. Grunfeld C, Pang M, Shimizu L, Shigenaga JK, Jensen P, Feingold KR. Resting energy expenditure, caloric intake and short-term weight change in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Am J Clin Nutr. 1992;55:455–60.

    CAS  PubMed  Google Scholar 

  20. Gerrior JL, Neff LM. Nutrition assessment in HIV infection. Nutr Clin Care. 2005;8(1):6–15.

    Google Scholar 

  21. Forrester JE, Sztam KA. Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations? Am J Clin Nutr. 2011;94(suppl):1683S–9S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. De Pee S, Semba RD. Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull. 2010;31:S313–44.

    Article  Google Scholar 

  23. Grobler L, Siegfried N, Visser ME, Mahlungulu SSN, Volmink J. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev [internet]. 2013;2:1–130 [cited 2014 June]. Available from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004536.pub3/abstract;jsessionid=959012C0888CE3A511C8E8F0A730E3D5.f04t02.

  24. Chandrasekhar A, Gupta A. Nutrition and disease progression pre-highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART? Am J Clin Nutr. 2011;94(suppl):1703S–15S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Raiten DJ. Nutrition and pharmacology: general principles and implications for HIV. Am J Clin Nutr. 2011;94(suppl):1697S–702S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Fawzi WW, Msamanga GI, Spiegelman D, Urasse EJN, McGrath N, Mwakagile D, Antelman G, Mbise R, Herrera G, Kapiga S, Willett W, Hunter DJ. Randomised trial of the effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998;16(351):1477–82.

    Article  Google Scholar 

  27. World Food Programme (WFP), PEPFAR, USAID, UNAIDS. Nutrition assessment, counselling and support for adolescents and adults living with HIV. New York: UNAIDS; 2014. Available from https://www.wfp.org/content/nutrition-assessment-counselling-and-support-adolescents-and-adults-living-hiv. Accessed 9 May 2016.

  28. Mehra, D, De Pee S, Bloem MW. Nutrition, food security, social protection, and health systems strengthening for ending AIDS. In: Ivers LC, editor. Food insecurity and public health. 1st ed. Boca Raton: CRC Press; 2015. p. 69–90.

    Google Scholar 

  29. Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, et al. Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J of Epidemiol. 2013;42:1754–71.

    Article  Google Scholar 

  30. Rose AM, Hall CS, Martinez-Alier N. Aetiology and management of malnutrition in HIV-positive children. Arch Dis Child. 2014;99(6):546–51.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schaible UE, Kaufman SHE. Malnutrition and infection: complex mechanisms and global impacts. PLoS Med [internet]. 2007;4(5):e115 [cited 2014 June]. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1858706/.

  32. HIV and infant feeding [internet]. Geneva: World Health Organization; 2010, 2014 [cited 2014 June]. Available from http://www.who.int/maternal_child_adolescent/documents/9789241599535/en/.

  33. Raiten DJ, Mulligan K, Papathakis P, Wanke C. Executive summary—nutritional care of HIV-infected adolescents and adults, including pregnant and lactating women: what do we know, what can we do, and where do we go from here? Am J Clin Nutr. 2011;94(suppl):1667S–76S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Rawat R, Humphrey JH, Ntozini R, Mutasa K, Iliff PJ, Stoltzfus RJ. Elevated iron stores are associated with HIV disease severity and mortaliy among postpartum women in Zimbabwe. Pub Health Nutr. 2009;12(9):1321–9.

    Article  CAS  Google Scholar 

  35. Van Lettow M, Fawzi WW, Semba R. Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Nutr Rev. 2003;61(3):81–90.

    Article  PubMed  Google Scholar 

  36. Shor-Posner G, Miguez MJ, Pineda LM, Rodriguez A, Ruiz P, Castillo G, et al. Impact of selenium status on the pathogenesis of mycobacterial disease in HIV-1—infected drug users during the era of highly active antiretroviral therapy. J Acquir Infect Defic Syndr. 2002;29(2):169–73.

    Article  CAS  Google Scholar 

  37. Ramakrishnan K, Shenbagarathai R, Kavitha K, Uma A, Balasubramaniam R. Thirumalaikolundusubramanian P. serum zinc and albumin levels in pulmonary tuberculosis patients with and without HIV. Jpn J Infect Dis. 2008;61(3):202–4.

    CAS  PubMed  Google Scholar 

  38. Shah S, Whalen C, Kotler DP. Severity of human immunodeficiency virus infection is associated with decreased phase angle, fat mass and body cell mass in adults with pulmonary tuberculosis infection in Uganda. J Nutr. 2001;131(11):2843–7.

    CAS  PubMed  Google Scholar 

  39. Hanrahan CF, Golub JE, Mohapi L, Tshabangu N, Modisenyane T, Chaisson RE, et al. Body mass index and risk of tuberculosis and death. AIDS. 2010;24(10):1501–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Swaminathan S, Padmapriyadarsini C, Sukumar B, Iliayas S, Kumar SR, Triveni C, et al. Nutritional status of persons with HIV infection, persons with HIV infection and tuberculosis, and HIV-negative individuals from Southern India. Clin Infect Dis. 2008;46(6):946–9.

    Article  PubMed  Google Scholar 

  41. Van Lettow M, Harries AD, Kumwenda JJ, Zijlstra EE, Clark TD, Taha TE, et al. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi. BMC Infect Dis [internet]. 2004;4(1):61 [cited 2014 June]. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC544350/pdf/1471-2334-4-61.pdf.

  42. Rwangabwoba JM, Fischman H, Semba RD. Serum vitamin A levels during tuberculosis and human immunodeficiency virus infection. Int J Tuberc Lung Dis. 1998;2(9):771–3.

    CAS  PubMed  Google Scholar 

  43. PrayGod G, Range N, Faurholt-Jepson D, Jeremiah K, Faurholt-Jepsen M, Aabye MG, et al. The effect of energy-protein supplementation on weight, body composition and handgrip strength among pulmonary tuberculosis HIV-co-infected patients: randomized controlled trial in Mwanza, Tanzania. Br J Nutr. 2012;107(2):263–71.

    Article  CAS  PubMed  Google Scholar 

  44. Sudarsanam TD, John J, Kang G, Mahendri V, Gerrior J, Franciosa M, et al. Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV-tuberculosis co-infection receiving directly observed short-course chemotherapy for tuberculosis. Trop Med Int Health. 2011;16(6):699–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Range N, Changalucha J, Krarup H, Magnussen P, Andersen AB, Friis H. The effect of multi-vitamin/mineral supplementation on mortality during treatment of pulmonary tuberculosis: a randomised two-by-two factorial trial in Mwanza, Tanzania. Br J Nutr. 2006;95(4):762–70.

    Article  CAS  PubMed  Google Scholar 

  46. Semba RD, Kumwenda J, Zijlstra E, Ricks MO, Van Lettow M, Whalen C, et al. Micronutrient supplements and mortality of HIV-infected adults with pulmonary TB: a controlled clinical trial. Int J Tuberc Dis. 2007;11(8):854–9.

    CAS  Google Scholar 

  47. Villamor E, Mugusi F, Urassa W, Bosch RJ, Saathoff E, Matsumoto K, et al. A trial of the effect of micronutrient supplementation on treatment outcome, T Cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. J Infect Dis. 2008;197(11):1499–505.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Saint Mary’s Hospital, 56 Franklin Street, Waterbury, CT, 06706, USA

    Anupama Paranandi

  2. Medicine/Infectious Diseases, Tufts Medical Center, 750 Washington Street, Boston, MA, 02111, USA

    Christine Wanke

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  1. Anupama Paranandi
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  2. Christine Wanke
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Correspondence to Christine Wanke .

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Editors and Affiliations

  1. World Food Programme , Rome, Italy

    Saskia de Pee

  2. School of Public Health, University of Arizona Mel and Enid Zuckerman, Tucson, Arizona, USA

    Douglas Taren

  3. World Food Programme, Nutrition Division , Rome, Italy

    Martin W. Bloem

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Paranandi, A., Wanke, C. (2017). HIV and HIV/TB Co-infection in Relation to Nutrition. In: de Pee, S., Taren, D., Bloem, M. (eds) Nutrition and Health in a Developing World . Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-43739-2_20

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  • DOI: https://doi.org/10.1007/978-3-319-43739-2_20

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