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Nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines
– Reported, May 29, 2013
Nutrition and several aspects of HIV infection are linked. The interaction between HIV/AIDS and nutritional status has been a defining characteristic of the disease since the early years of the epidemic. The rapid weight loss that accompanied the disease in the pre-antiretroviral period implied that nutrition has an important role to play in the maintenance of good health with this disease. HIV infection affects nutritional status by causing reductions in dietary intake, increased energy requirements, nutrient malabsorption and loss, and complex metabolic alterations that culminate in weight loss and wasting. The effects of HIV on nutritional status and nutritional status on HIV disease progression have been extensively studied. Studies show that micronutrient deficiencies are common in HIV disease. Low intakes of thiamine, riboflavin, niacin, vitamin B6, vitamin E, iron, selenium and zinc are associated with more rapid progression of disease and these micronutrients seem to play a role in improving malnutrition-related immune function.
Macronutrient intakes and metabolism also play an important role in HIV disease progression. Studies have shown that the energy needs of HIV-infected individuals increase even when they show no symptoms and that opportunistic infections lead to higher protein and micronutrient utilization . Although antiretroviral therapy can contribute to the maintenance of health and avoidance of weight loss, malnutrition and wasting may still be observed in some patients. In fact, antiretroviral therapy may impair the absorption and metabolism of nutrients and in so doing, influence nutritional status and body composition. Although important roles for specific macro- and micronutrients in immune function maintenance have been identified, more recent information suggests that generalized malnutrition may explain much of the immune dysfunction that accompanies HIV/AIDS.
Clearly, the nutritional status of persons living with HIV/AIDS should be assessed on a regular basis in order to ascertain the level of nutrition intervention needed for maintenance or improvement of their nutritional status. Given the fact that the Caribbean ranks second to Sub-Saharan Africa in the prevalence of adults living with HIV and the importance of nutrition in slowing the progression and improving health outcomes, it is surprising to find only a few published regional studies investigating the nutritional status of PLWHA.
Strategies to correct and prevent malnutrition among PLWHA must take into consideration the socio-economic factors that might hinder implementation of agreed action plans. For example, given the fact that many of the PLWHA did not have more that a primary school education, demonstrations involving the family members responsible for procuring and preparing meals as well as verbal and written instructions might be effective in improving the nutritive value of foods consumed. Such intervention strategies have been known to improve dietary practices and nutritional status of recipients. Furthermore, the fact that the majority of PLWHA were unemployed would suggest difficulties in accessing nutritious foods on a regular basis. We also recommend the distribution of minerals and vitamin supplements with the hamper that are given to clients with each clinic visit as a means of preventing micronutrient deficiencies in this vulnerable group. To further facilitate good nutritional practices among clinic attendees, we recommend nutritional counselling at each clinic visit. Such sessions should assist clients to develop a pragmatic approach to addressing nutritional issues relevant to the disease such as malnutrition, wasting, fat accumulation, hyperlipidaemia, insulin resistance, immune dysfunction and the possible increased risk of cardiovascular disease. Clearly, the member(s) of the health team responsible for addressing the nutritional implication of these co-morbidities must be familiar with the latest evidence-based research in these areas.
An important finding is the strong correlation between CAMA and weight and BMI among participants and supports the use of CAMA as a good proxy for predicting lean body mass in this population. This is important as lean body mass depletion is associated with opportunistic infection and progression of the disease. Moreover, the fact that triceps skinfold and MUC can be taken even when the client is unable to stand makes them useful in approximating lean body mass in bedridden clients. We have presented gender specific equations that might be used for approximating weight and BMI changes in this clinic population. The high specificity of CAMA might be useful in the identification of PLWHA who might be responding adequately to treatment. As such CAMA might be a good tool for monitoring nutritional status in this population. Finally, the results of this study suggest that males in this population appear to be at increased risk for depletion in lean body mass . Clearly, this should be taken into consideration in the development of strategies aimed at improving the nutritional status of clinic attendees.
The failure to randomly select participants might have resulted in a sample of HIV persons who were well enough to attend clinic during the study and might not reflect the general population of HIV/AIDS clinic attendees or the general population of PLWHA in St Vincent and the Grenadines. This type of selection bias would also affect all estimates determined in this study. In the study, the HIV/AIDS status of the control group was not confirmed by diagnostic tests. This can influence the magnitude of the differences observed between the groups. Also, the official status and length of infection is not known for most of the participants. This could have influence the nutritional status as assessed.
CREDITS.
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