Download - AIDS and Nutrition: Scene-Setter Suneetha Kadiyala RENEWAL 3 Regional Workshop 12 th March 2007
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AIDS and Nutrition:
Scene-Setter
Suneetha Kadiyala
RENEWAL 3 Regional Workshop
12th March 2007
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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
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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
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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?
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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?
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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
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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?
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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 ?
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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?
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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?
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Potential Collaborations
• TASO• University of Illinois (Paul McNamara)• AMPATH• Kaunda Foundation• Project Concern International