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Consultation on Nutrition and HIV/AIDS in Africa: 

Consultation on Nutrition and HIV/AIDS in Africa International Convention Centre (ICC) Durban, South Africa 10−13 April 2005 Evidence, lessons and recommendations for actions

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Where do we stand?: 

Where do we stand? Sub-Saharan Africa is home to more than 60% of all people living with HIV/AIDS. Both HIV infection and malnutrition rates are rising in the region. African governments are urgently facing a range of policy and programme challenges related to food, nutrition, and scaling-up programmes to accelerate access to life-saving antiretroviral therapy (ART) and HIV care.

Consultation on Nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for actions: 

Consultation on Nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for actions A direct response to Resolution 57.14 of the World Health Assembly, 22 May 2004 on "Scaling up treatment and care within a coordinated and comprehensive response to HIV/AIDS". This resolution urges Member States as a matter of priority to pursue policies and practices that promote integration of nutrition into a comprehensive response to HIV/AIDS article [2(3)(h)].

The Goal of the consultation is to:: 

The Goal of the consultation is to: Develop strategies that are both evidence-based and feasible to help improve the health status of people living with HIV/AIDS in southern and eastern African countries. Review and disseminate the latest evidence on nutrition and HIV/AIDS, and thereby help ensure nutrition is integrated as part of a comprehensive response to HIV/AIDS. Identify a research agenda to fill the critical gaps in knowledge.

The Process, TAG and partners : 

The Process, TAG and partners Joint NHD/HIV/AIDS Departments effort Contributions and partners WHO Technical Advisory Group on Nutrition and HIV/AIDS 230 participants from 20 countries, 6 UN agencies, 8 Regional Groups and 21 NGOs - with bilaterals, research groups and institutions, donors and PLWHA

Several firsts… : 

Several firsts… First international consultation convened by WHO to bring nutrition and HIV/AIDS people together in direct response to the 2004 WHA Resolution. A full scientific review of the evidence was undertaken to examine the issue from a nutritional and lifecycle perspective. All age groups and stages of disease were considered. The interaction between nutrition and ARV therapy was also reviewed. Teams of 3 to 4 people coming from 20 countries came together to share experiences and plans, and to help us identify priority actions and research questions. A participants Statement put out by WHO and its partners in this area to raise and solicit a solid commitment. The outcome of the meeting will be presented to WHO Executive Board in one month.

Facts - 1: 

Facts - 1 The relationship between nutrition and HIV/AIDS in complex. HIV progressively damages the immune system and malnutrition itself may also increase the susceptibility to infection Both scenarios can make a person susceptible to a range of opportunistic infections and conditions, such as weight loss, fever and diarrhea These conditions can also lower food intake because they both reduce appetite and interfere with the body's ability to absorb food Evidence suggests that malnourished adults and children initiating ART require adequate food to support nutritional recovery

Facts - 2: 

Facts - 2 As in the general population, a diet that provides the full range of essential micronutrients is important to the health of people living with HIV and AIDS. No evidence that food and dietary improvements alone can stop people who are infected with HIV from progressing to AIDS. Comprehensive care for people living with HIV and AIDS should include both good nutrition and antiretroviral therapy, where clinically indicated.

Scientific review on nutrition and HIV/AIDS: 

Scientific review on nutrition and HIV/AIDS Micronutrients How HIV infection leads to micronutrients deficiency, and how deficiencies/supplementation may affect various transmission and progression-related outcomes Macronutrients (Energy and Protein) How HIV infection affects energy/protein requirements, and how deficiencies/supplementation may affect various transmission and progression-related outcomes Infant feeding and HIV transmission Growth faltering and wasting in children Maternal Nutrition or pregnant and lactating women Nutrition and ARVs How nutrition may affect ARV efficacy and how ARVs may lead to better nutritional status on the one hand and dyslipidemia and insulin resistance on the other Summary, conclusions and recommendation (NHD)

Key Findings of the Review: Macronutrients: 

Key Findings of the Review: Macronutrients Resting energy expenditure rates (REE) are increased during HIV infection Therefore energy requirements are higher in PLWHA: Asymptomatic: there is a 10% increase in kcal/day Symptomatic: there is a 20-30% increase in kcal/day Children with weight loss: there is a 50-100% increases in kcal/day

Key Findings of the Review: Macronutrients : 

Key Findings of the Review: Macronutrients There is a common belief that protein requirements are increased due to HIV infection However, evidence suggests that low energy intake combined with increased energy demands of HIV infection are the major driving forces behind HIV-related weight loss and wasting. Although protein metabolism may be affected by HIV infection, there is no evidence that increasing protein intakes will improve protein status or muscle mass. Nitrogen balance studies needed Therefore, data are insufficient to support an increased protein requirement due to HIV infection. 12-15% of energy intake should come from protein

Key Findings: Micronutrients : 

Key Findings: Micronutrients Micronutrient deficiencies are frequently present in HIV-infected adults and children. Micronutrient intake at RNI levels are recommended for HIV-infected children and adults. These needs are best met through consumption of a diverse diet and fortified foods Some studies have shown that micronutrient supplements may delay HIV disease progression and prevent MTCT. However, additional research is needed to confirm these results and their generalizability

Key Findings: Pregnant and lactating women: 

Key Findings: Pregnant and lactating women Pregnancy and lactation do not hasten the progression of HIV infection to AIDS. HIV infected pregnant women gain less weight and experience more frequent micronutrient deficiencies During lactation the change in weight is greater in HIV infected mothers. Optimal nutrition of HIV infected mothers during pregnancy and lactation increases weight gain, and improves pregnancy and birth outcomes.

Key Findings: HIV-infected children: 

Key Findings: HIV-infected children HIV-infection impairs the growth of children early in life. Growth faltering is often observed even before the onset of symptomatic HIV infection. Poor growth reflects the risk of child mortality in HIV-infected children. In HIV infected children viral load, chronic diarrhoea and other opportunistic infections impair growth. The growth and survival of HIV-infected children is improved by prophylactic cotrimaxozole, ARV therapy and the early prevention and treatment of opportunistic infections. Improved dietary intake enables HIV+ children to regain lost weight after opportunistic infection.

Key Findings: Infant feeding and HIV: 

Key Findings: Infant feeding and HIV Maternal CD4, blood and BM viral load are associated with increased risk of HIV transmission during BF The risk of HIV transmission during BF breastfeeding is constant over time New data from Zimbabwe confirm earlier reports indicating that risk of breastfeeding-associated HIV transmission is increased with early mixed breastfeeding compared with early exclusive breastfeeding (EBF) Data from several studies report that education/counseling increase frequency and duration of EBF No data available on impact of early breastfeeding cessation on mortality, HIV-free survival

Nutrition and ARV interactions: 

Nutrition and ARV interactions Dietary and nutritional assessment is an essential part of comprehensive HIV care both before and during ART. Long term use of ART can be associated with metabolic complications. The value of ARV therapy far outweighs the risks. However, these metabolic complication must be adequately managed, when they occur. There is a need to look at interactions between nutrition and ARV's in chronically malnourished populations. The effect of traditional remedies and dietary supplements on the safety and efficacy of ARV drugs needs to be evaluated.

Action points:: 

Action points: 1. Conduct advocacy to strengthen political commitment and improve the positioning of nutrition in national policies and programs Use existing advocacy tools, and develop news ones, as needed, to sensitize decision-makers about the urgency of the problem and impact on development targets. Such advocacy should be to increase commitment and support for improved nutrition, in general, and for addressing the nutritional needs of HIV-affected and infected populations, in particular.

Action points:: 

Action points: 2. Develop practical nutrition assessment tools and guidelines for home, community, health facility-based and emergency programmes Validate simple tools that can be used by front line workers to assess diet, nutritional status, and food security so that nutrition support provided within HIV programs is appropriate to individual needs. Develop standard operating procedures to define the nutrition actions that should be taken at health-facility and community levels and improve quality of care (who, what, when, and for how long). Review and update existing treatment protocols to include nutrition/HIV considerations (e.g., integrated management of adult illness, ARV treatment, nutrition in emergencies)

Action points:: 

Action points: 3. Implement at scale existing interventions for improving nutrition in the context of HIV. Accelerate implementation of the Global Strategy for Infant and Young Child Feeding. Renew support for the Baby Friendly Hospital Initiative. Accelerate training and use of guidelines and tools for infant feeding counselling and maternal nutrition in PMTCT programs. Expand access to HIV counselling and testing so that individuals can make informed decisions and receive appropriate advice and support on nutrition, including in emergency settings. Implement WHO protocols for vitamin A, iron-folate, zinc, multiple micronutrient supplementation and management of severe malnutrition.

Action points:: 

Action points: 4. Build a learning environment at all levels, through operations research and information sharing, to facilitate evidence-based programming Develop and implement operations research to identify effective interventions and strategies for improving nutrition of HIV infected and affected adults and children. Document results, publish findings in journals, and ensure access to lessons learned at all levels.

Action points:: 

Action points: 5. Develop human capacity and skills to ensure that nutrition is appropriately implemented in HIV prevention, treatment, and care programs Include funding for nutrition capacity development in HIV scale up plans. Incorporate nutrition into training of front line health, community and home-based care workers. Specific skills such as nutritional assessment and counselling, and program monitoring and evaluation should be included. Such training should be not favour particular commercial interests. Strengthen the capacity of government and civil society to develop and monitor regulatory systems to prevent commercial marketing of untested diets, remedies, and therapies for HIV-infected adults and children.

Action points:: 

Action points: 6. Incorporate nutrition indicators into HIV/AIDS monitoring and evaluation plans Include appropriate nutrition process and impact indicators for community surveillance, and national, regional, and international progress reporting. Several process and impact indicators proposed.