Basic Principles of Nutrition, HIV and AIDS: Making Improvements in Diet to Enhance Health

*Ezinna E. Enwereji, Martina C. Ezeama and Prince E.N. Onyemachi*

## **Abstract**

The relationships among nutritional status, infectious diseases and immune system suggest nutrition as a cofactor in human immunodeficiency virus (HIV) progression. Poor nutritional status and HIV infection interact with each other leading to the development of opportunistic infections, malignancies, debilitation and death. Infection by human immunodeficiency virus (HIV) is characterized by progressive destruction of immune system. Malnutrition that is multifactorial is, therefore, one of the major complications of HIV infection that is poorly addressed in HIV intervention. Early nutritional intervention when individuals living with HIV show active weight loss is important in maximizing gain of lean body mass. Since malnutrition is the major complication of HIV infection, which results in wasting syndrome, it should be termed as a prognostic factor in advanced HIV infection though malnutrition is a result of not only HIV infection but also numerous HIV-associated complications. Studies have recommended clinical trials to evaluate prevalence of malnutrition among those living with HIV so as to examine the efficacy of supplementing with specific nutrients at various stages of HIV infection as well as combining therapeutic foods for treating malnutrition with antiretroviral treatment in children of HIV-positive mothers. Therefore, good nutrition guarantees excellent health in HIV infection.

**Keywords:** HIV, malnutrition, nutrition security, therapeutic foods, lipodystrophy, opportunistic infections

### **1. Introduction**

Infants born to mothers living with HIV have poorer growth and higher morbidity and mortality than those born to mothers who are not infected with HIV. Furthermore, abnormalities in growth are common in children infected with HIV. Children living with HIV and AIDS are at increased risk of malnutrition. Chronic infections, especially HIV and AIDS, can lead to poor appetite and growth because food intake and nutrient absorption which the body needs in order to fight the infection are defective. The result is a weakened immune system that is ill equipped to fight the virus and other infections like tuberculosis. This accounts for the severe acute malnutrition seen in most people living with HIV. To increase the chances of survival of these people, therapeutic foods for reducing malnutrition should be combined with antiretroviral

treatment to stop the infection from progressing [1, 2]. Studies indicate that multiple nutritional abnormalities occur relatively early in human immunodeficiency virus (HIV) infection, and also that decreased plasma levels of vitamins B6, B12, A, E and zinc are correlated with dietary intake and associated with significant alterations in immune response and cognitive function for people living with HIV infection. To determine the level of intake consistent with normal plasma nutrient levels, there is a need to examine nutrition status in relation to food consumption and nutrient supplementation in HIV seropositives [3, 4].

In developing countries where most families live in abject poverty and are exposed to infections due to poor nutrition and sanitation and contaminated drinking water, the benefits of HIV-positive mothers breastfeeding infants will greatly reduce the risk of HIV infection when ARVs are combined with good nutrition. In this instance, the nutrients and antibodies present in breast milk will make the healthiest food for such babies, thereby providing them with unmatched protections from HIV infection, diseases and even death. Therefore, good nutrition will lay the foundation for healthy thriving and productivity of people living with HIV. Now more than ever, there is global recognition that good nutrition is the key to sustainable development. But good nutrition is more than about just ending hunger: it is also crucial to achieving some targets, including ending poverty, achieving gender equality, ensuring healthy lives, promoting lifelong learning, improving economic growth, building inclusive societies and ensuring sustainable consumption [5–7]. Nutritional status may have an impact at all stages of HIV disease since most of the clinical features of HIV infection originate from nutritional problems which are exacerbated by the presence of malnutrition. However, inadequate food intake, due to a variety of etiologies, malabsorption and altered metabolism, may also contribute to malnutrition. Additionally, factors in food, including reduced micronutrient levels, can negatively affect the immune functions and result in increase in the progression of HIV infection at all stages [8–11].

The frequent weight loss in people living with HIV worsens the prognosis of the infection. Their reduced dietary intake, increased digestive problems and energy expenditure result in severe malnutrition. Therefore, the nutritional support and its association with anabolic agents to promote tissue growth and physical activity should be carefully selected [12–14]. The adverse effects of some new antiretroviral drugs could influence the patients' nutritional state as well as compliance to treatments. In cases where lipodystrophy, whose etiology is still unknown and no treatment has yet been found, and metabolic disorders like dyslipidemia, glucose intolerance and others occur, particular attention should be given since these conditions are likely to increase cardiovascular risks and, moreover, they are generally sensitive to a dietary approach [2, 15, 16].

Achieving and maintaining optimal nutrition is considered an important strategy for ensuring food security for people infected with HIV. A good nutrition can improve an individual's immune function, limit disease complications, and improve quality of life and survival. This is necessary because macronutrient interventions, such as balanced diet of high protein, high carbohydrate and high fat, will reduce morbidity and mortality of people living with HIV infection. Evidence has shown that macronutrient supplementation will reduce HIV-related complications, such as opportunistic infections or death. Food insecurity has been recognized as the key driver of HIV epidemic and a potential cause of poor health outcomes among people living with HIV and AIDS. Food insecurity is linked with heart disease, diabetes, obesity, depression and is independently associated with incomplete HIV RNA suppression among HIV-infected individuals [17]. These call for holistic and comprehensive response in minimizing chronic nutrition insecurity among HIVpositive persons. Therefore, the need to elucidate ways of sustaining long-term nutritional support for HIV-positive individuals to minimize nutritional insecurity and guarantee security in livelihood should not be underestimated.

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*Basic Principles of Nutrition, HIV and AIDS: Making Improvements in Diet to Enhance Health*

Nutrition is defined as the sum total of the processes by which a living organism receives materials from its environment and uses them to promote its own vital activities. The materials which it receives are known as nutrients. Nutrition is also the science that interprets the relationship between the food consumed and its function on the living organism. It relates to food intake and functions in the body for the overall well-being of the individual. It includes the intake of food, liberation of energy, elimination of waste and all the synthesis or processes that are essential for the maintenance of growth and reproduction of the individual [18]. The relationship between nutrition and HIV is a vicious cycle, similar to the relationship between nutrition and other infections. Compromises in nutritional status and poor nutrition further weaken the immune system and thereby increase susceptibility to opportunistic infections. Poor nutrition increases the body's vulnerability to infections, and infections aggravate poor nutrition. Inadequate dietary intake leads to poor nutrition and lowers immune system functioning. Poor nutrition reduces the body's ability to fight infections and therefore helps increase the incidence, severity and length of infections. Research has shown that clinically, there are synergistic interactions between infection, nutritional status and immune functions. Infectious diseases, no matter how mild, will influence nutritional status and conversely cause nutrient deficiencies that are sufficiently severe to impair resistance to infection [19, 20].

The foundations of good nutrition include improving women's nutrition before, during and after pregnancy; promoting and supporting exclusive breastfeeding for the first 6 months of a child's life, and continued breastfeeding up to age 2 or beyond; providing timely, safe, appropriate and high-quality complementary foods as well as micronutrient interventions. In this regard, nutritional status should be assessed using biochemical measurement of nutrient levels, dietary history, anthropometry and clinical examination for the signs and symptoms of nutritional deficiency or excess. In managing emergencies, UNICEF's programs have concentrated their interventions on foundations of good nutrition, prevention and treatment of malnutrition to vulnerable groups including those living with HIV and AIDS irrespective of whether or not they are using highly active antiretroviral therapy (HAART) which has been postulated to reduce the occurrence of human immunodeficiency virus (HIV)-associated weight loss and wasting. To this assumption, studies have shown that there is no difference in the extent of wasting experienced between those who received HAART and those who did not. It has been shown that the weight loss or wasting in HIV infection can be radically reduced with nutrition intervention. The good news is that the goal of nutritional intervention is usually to preserve lean body mass and provide adequate nutrients as well as minimize symptoms of malabsorption and thereby improve quality of life. This is why specific nutritional therapy ranges from oral supplements to home total parenteral nutrition

Following interventions proffered by several organizations and researchers to reduce malnutrition among persons living with HIV, the definition of wasting developed by the Centers for Disease Control and Prevention (CDC) in 1987 has been adopted by researchers. This definition requires an involuntary weight loss of >10% of baseline body weight plus diarrhea, fever, or weakness for >30 days to be termed as wasting. Most researchers have now dropped the comorbid conditions of wasting and have simply espoused weight loss >10% as the definition of HIV-associated wasting. In the CDC definition, "baseline weight" is neither defined nor time frame specified for the weight loss. Presently, most researchers are using the definition of wasting as that which will require a weight loss >5% in a 6-month period and that in which the weight loss is sustained. Some other studies have

*DOI: http://dx.doi.org/10.5772/intechopen.84719*

**2. The foundations of good nutrition**

(TPN) which is individualized [21, 22].

*Basic Principles of Nutrition, HIV and AIDS: Making Improvements in Diet to Enhance Health DOI: http://dx.doi.org/10.5772/intechopen.84719*
