**Abstract**

HIV/AIDS can cause malnutrition directly and also indirectly through opportunistic infections (OIs). Infectious diarrhoea and tuberculosis are the commonest OIs linked to malnutrition in HIV/AIDS. Environmental enteric dysfunction has now been identified to play a significant role in HIV-malnutrition. Food insecurity is bidirectionally associated with aggravation and perpetuation of HIV infection. Increasingly, drugs used in antiretroviral therapy have been recognised to lead malnutrition in many ways. Both HIV and malnutrition are most prevalent in the poorest areas of the world, and there is a convergence of etiological factors. Malnutrition depresses every aspect of immune function. Deficiency of key micronutrients like iron, folic acid, zinc, selenium and vitamins A, C and D also adversely affects immune function. Recent research has led to a greater understanding of these mechanisms. Immune dysfunction secondary to malnutrition is referred to as nutrition-associated immunodeficiency. Hence it is easy to surmise that malnutrition and HIV/AIDs are a deadly duo.

**Keywords:** HIV/AIDS, malnutrition, immunity, environmental enteric dysfunction

#### **1. Introduction**

HIV/AIDS and malnutrition form a deadly duo with each one fuelling the other. Malnutrition increases susceptibility to infection by causing immune dysfunction in manifold ways. The depressed immune status can amplify HIV replication and accelerate progression of HIV disease to AIDS. Malnutrition increases the risk of death on initiation of ART in PLHA, and untreated HIV/AIDS puts individuals at risk for malnutrition. The same is more acute in infants and children under 5 years of age [1, 2]. Untreated or advanced HIV/AIDS is again associated with a compromised immune status that makes these patients susceptible to opportunistic infections. Of these, tuberculosis is the most common and most debilitating one. Apart from TB, common infections like pneumonia, kala-azar, meningitis and malaria are also more common in these patients. Infections and the chronic low-grade inflammatory state perpetuated by HIV infection suppress appetite, increase catabolism of muscles and push patients towards malnutrition. Loss of strength means low earning capacity and loss of livelihood. The social stigma of HIV fractures social and family bonds. All of them further push patients towards impoverishment and malnutrition.
