AIDS treatment, nutrition and food supplements

WHO Fact sheet

30 March 2005 -- HIV progressively damages the immune system, which can make a person susceptible to a range of opportunistic infections and lead to conditions such as weight loss, fever and diarrhoea.

These HIV-related conditions can lower food intake by reducing appetite and interfering with the body's ability to absorb food. HIV also alters metabolism which can often lead to increased energy and nutrient requirements for people with HIV-infection.

People with HIV who are also suffering from hunger and/or nutritional deficits are more likely to fall ill with opportunistic infections and less likely to be able to recover from them. In addition, people who are sick with HIV-related illnesses are also less able to work normally, to earn income or to produce food, which can lead to nutritional deficits both for themselves and for their dependants.

As in the population at large, a good diet that provides the full range of essential micronutrients is important to the health of people infected with HIV and can help bolster the immune system, boost energy levels and maintain body weight and well-being. Guidelines published jointly by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) in 2003 offer simple dietary suggestions for people living with HIV and AIDS.[1]

Over the last few years, several studies have been carried out to investigate the role of micronutrient supplements on the course of HIV/AIDS disease. The results of these studies have not been conclusive.[2]WHO and UNAIDS recommendations for micronutrient supplementation are therefore the same for people whether they are infected with HIV or not.

Although they may help to meet increased nutritional requirements, nutritional supplements cannot replace eating a balanced and healthy diet. Furthermore, supplements are often not available, are expensive and may leave less money for food. Whether a person is infected with HIV or not, WHO and UNAIDS recommend a good mixed diet, whenever possible, rather than dietary supplements.

WHO and UNAIDS recommend periodic, high-dose vitamin A supplements for all children who are vitamin A deficient, including those who are HIV-infected, as these can reduce morbidity and mortality.

According to current UN feeding recommendations, infants of HIV-negative mothers and mothers who do not know their HIV status should be exclusively breastfed for the first six months of life, and thereafter should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to 24 months or beyond.

However, for HIV-infected mothers, to reduce the risk of HIV transmission while minimizing the risk of other causes of morbidity and mortality, when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should then be discontinued as soon as the conditions for replacement feeding are in place. Women should receive counselling about the risks and benefits of the various infant-feeding options, and support for their choice.

Feeding non-breastfed infants and young children from 6 months to 24 months of life poses particular challenges, especially in countries where formula, cow's milk and animal-source foods are not readily available. Guiding principles for feeding non-breastfed children have recently been developed. [3]

Although good food and diet are important for the wellbeing of people living with HIV/AIDS, there is no evidence that food and/or dietary supplements alone will stop people who are infected with HIV from progressing to AIDS. Comprehensive care for people living with HIV and AIDS needs to include prophylaxis and treatment for opportunistic infections and antiretroviral therapy, where indicated and a healthy, balanced diet.

Antiretroviral therapy has been shown in numerous studies to reduce the replication of HIV in the body, reduce the incidence of opportunistic infections and AIDS-related illness and improve quality of life. Optimal antiretroviral treatment requires safe, clean drinking water and a balanced diet rich in energy, protein and micronutrients. Secure, good nutrition and clean water may make antiretroviral therapy easier to take and help ensure that treatment works effectively.

More research is needed to examine the micronutrient needs of people living with HIV/AIDS and the best role for micronutrient supplements in HIV/AIDS infected populations. There is no evidence that, taken alone, micronutrient supplements will prevent disease or prolong life for people living with HIV and AIDS.

[1] - Living well with HIV/AIDS: A manual on nutritional care and support for people living with HIV/AIDS, World Health Organization / Food and Agriculture Organization, 2002
[2] - Nutrient requirements for people living with HIV/AIDS: report of a technical consultation, WHO, May 2003, available at http://www.who.int/nut/documents/hivaids_nut_require.pdf.
[3] - Guiding principles for feeding non-breastfed children, .WHO, in press.