**4.9 Substance abuse and psychiatric disorders**

HIV infection and chronic drug abuse both compromise nutritional status. There is a synergistic effect in HIV-positive drug users that leads to wasting and significantly impacts mortality. Illicit drug use may interfere with nutrient absorption, mute appetite and alter metabolism. Lifestyle of chronic drug users may compromise their access to food, food selection, housing, family and social support [94]. Use of injection drugs correlated with lower protein intake in the NFHL cohort study [14]. IV drug can be associated with HIV-HBV or HIV-HCV coinfections. Patients with hepatitis frequently lose weight and develop anaemia and neutropenia. As liver disease advances, anorexia, dietary intolerance and limitation of nutrient intake occur [95, 96]. AIDS-related dementia and neuropsychiatric disorders can cause malnutrition as the ability of patients to care for themselves is compromised. Many may forget to eat and others may be unable to prepare balanced meals [97].
