HIV/AIDS and Malnutrition Locked in "Vicious Cycle"

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by Charlene Porter, Washington File, 16 Oct 2006

Washington -- In many of the world’s poor regions, where HIV/AIDS has taken the worst toll, the virus and malnutrition are locked in a “vicious cycle” that worsens the impact of both.

“Insufficient intake [of calories] can enhance the progression of the virus,” said Suneetha Kadiyala, a scientist at the International Food Policy Research Institute (IFPRI) who participated in a panel on food security and HIV/AIDS at the Woodrow Wilson Center in Washington October 16.

The discussion was held in observance of World Food Day. (See related article.)

After six years of study, Kadiyala said, the damaging relationship between malnutrition and HIV/AIDS is becoming better understood. It can begin when a family member first begins to exhibit symptoms after HIV infection. His or her capacity to work – whether as a farmer or a wage earner – is diminished, possibly affecting household income and the availability of food for an entire family.

Already compromised by the presence of HIV, the immune system becomes even less effective at defending against infection when the body is malnourished.

As anti-retroviral drugs (ARV) become more widely available in poor regions where AIDS is taking the greatest toll, Kadiyala said, scientists also are discovering that malnutrition compromises the efficacy and increases the toxicity of medications.

“Improving the nutrition status of people is critical if ARV treatment is going to be successful,” she said.

Food insecurity also can increase individual risk for exposure to HIV, researchers have found. People who are hungry will leave their homes for food, expanding their social exposures and engaging in desperate behaviors that can make them more vulnerable to infection.

With this hard-won understanding, IFPRI is working to create expanded networks of policy-makers and health experts to raise awareness about the links among poverty, nutrition and disease in hopes of finding wider solutions.

Even though recent research is revealing more about the complexity of the interaction between HIV/AIDS and malnutrition, the need to include food assistance in a program to support those suffering from HIV/AIDS is well understood.

The U.N. World Food Programme, the sponsor of World Food Day, is feeding 9 million people infected with HIV/AIDS, according to Jordan Dey, director of the program’s U.S. relations office.

“Hunger is the greatest public health threat, and it undermines a nation’s development,” Dey said.

The United States is the largest donor of food assistance worldwide, investing more than $2.4 billion in that cause in 2005, according to a report presented to the U.S. Congress in early 2006.

The U.S. Agency for International Development and the U.S. Department of Agriculture are key players in delivering food assistance and supporting efforts under the President’s Emergency Program for AIDS Relief (PEPFAR) to reduce malnutrition among people living with HIV/AIDS and those affected by the disease.

Report on Food and Nutrition for People Living with HIV/AIDS (PLWHA), released by the Global AIDS Coordinator’s Office in May, outlines the specific objectives of PEPFAR nutrition programs:

• Improve the quantity and quality of diets among PLWHA,

• Build or replenish body stores of essential nutrients,

• Prevent or stabilize weight loss,

• Preserve and gain muscle mass,

• Prevent diarrhea and other infections that affect nutritional status, and

• Speed recuperation from HIV-related symptoms that affect food consumption and dietary intake.

The full text of the report (PDF, 29 pages) is available on the State Department Web site.

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