Nutritional aspects of HIV-associated wasting in sub-Saharan Africa.
The twin global epidemics of HIV infection and food scarcity disproportionately affect sub-Saharan Africa, and a significant proportion of patients who require antiretroviral therapy (ART) are malnourished because of a combination of HIV-associated wasting and inadequate nutrient intake. Protein-calorie malnutrition, the most common form of adult malnutrition in the region, is associated with significant morbidity and compounds the immunosuppressive effects of HIV. A low body mass index (BMI), a sign of advanced malnutrition, is an independent predictor of early mortality (<6 mo) after ART initiation in several analyses, and recent studies show an association between early weight gain when receiving ART and improved treatment outcomes. The cause of the observed increase in mortality is uncertain, but it is likely due in part to malnutrition-induced immune system dysfunction, a higher burden of opportunistic infections, and metabolic derangements. In this article, we describe the epidemiology of HIV infection and malnutrition in sub-Saharan Africa, potential causes of increased mortality after ART initiation among patients with a low BMI, recent studies on post-ART weight gain and treatment outcome, and trials of macronutrient supplementation from the region. We close by highlighting priority areas for future research.
Division of Infectious Diseases, Vanderbilt University, Nashville, TN 37232-2582, USA. john.r.koethe@vanderbilt.edu
John R
JR
Koethe
Douglas C
DC
Heimburger
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology; D019247:HIV Wasting Syndrome / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000150:complications; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss
D044966:Anti-Retroviral Agents