Macronutrient Supplementation to HIV and TB Patients during Treatment

Excerpt

In low-income countries, undernutrition and infectious diseases are major health problems. Their coexistence is partly due to poverty being an important determinant of both problems, but also due to the two-way causal interactions between nutritional deficiencies and infections, whereby infections exacerbate nutritional deficiencies, which in turn increase infectious disease morbidity and mortality. Most research has been conducted on the relationship between generalized malnutrition or micronutrient deficiencies and childhood infections. Control of infectious diseases is now considered important in prevention of undernutrition, and evidence-based nutritional interventions have been established to reduce childhood morbidity and mortality.

In contrast, not much research has been done to develop effective nutritional interventions that target two of the major infectious diseases in adults: tuberculosis (TB) and HIV infection. Despite obvious differences between HIV and TB, both are characterized by wasting and often affect underprivileged individuals. Furthermore, HIV is a strong determinant of TB, so co-infections are common. In some settings, more than half of the TB patients starting anti-TB treatment are HIV coinfected (Range et al., 2001). Similarly, a large proportion of HIV-patients starting ART treatment will also have TB, partly because newly diagnosed TB patients are tested for HIV and referred for treatment and because HIV patients are screened for TB.

Some studies have shown that micronutrient supplementation may affect progression and transmission of HIV (Fawzi et al., 2002, 2004), and micronutrients may be of importance for primary TB infection or actual TB disease (van Lettow and Whalen, 2008). As such, there might be a role for micronutrient interventions that target individuals at risk of HIV and TB infections or in the early stages of these infections. Patients with advanced HIV infection and clinical TB disease often live in food-insecure settings, and their habitual diet does not contain enough energy and nutrients to meet their requirements. There is, therefore, a need for effective nutritional interventions that target HIV and TB patients as part of comprehensive medical and social care packages. In addition to ameliorating food security and nutritional status, such interventions may also have a beneficial impact on disease and treatment outcomes.