Food scarcity disproportionately affects sub-Saharan Africa, which carries 67 percent of the global burden of HIV. Due to a combination of HIV-associated wasting and poor diet or chronic insufficient food intake, malnourishment endangers the lives of a significant number of individuals with HIV who are being treated with antiretroviral therapy.
The most common form of adult malnutrition in the region, protein-calorie, compounds the immunosuppressive effects of HIV. Advanced nutrition deficiency, usually measured by low body mass index, is an independent predictor of early mortality after therapy. Increased mortality is likely due in part to malnutrition-induced dysfunction of the immune system and metabolism and a higher incidence of infections.
A recent article published in The American Journal of Clinical Nutrition covers the epidemiology of HIV infection and malnutrition in sub-Saharan Africa, potential causes for accelerated death rates in low-BMI patients, recent studies and clinical trials. The co-authors are Dr. John Koethe, a Fogarty International Clinical Research Fellow working in Zambia, and Dr. Douglas Heimburger, professor of medicine at Vanderbilt’s Fogarty-supported Institute for Global Health.
The authors detail hopeful studies and trials. Nutritional supplements that are well-timed and properly balanced offer potential to improve the health of people with advanced HIV and malnutrition. There is an association between early weight gain post-therapy and improved outcomes.
Koethe and Heimburger support more emphasis on malnutrition as a component of HIV care and acknowledge that it will require a shift in policy and funding priorities.
Nutritional Aspects of HIV-Associated Wasting in sub-Saharan Africa. John R. Koethe and Douglas C. Heimburger. American Journal of Clinical Nutrition 2010 Apr; 91(4):1138S-1142S.