Nutrition
8.1 Nutrition
Good nutrition is an essential part of HIV/AIDS treatment. When a person is infected with HIV, their immune system is compromised (see stages of HIV infection) and becomes increasingly vulnerable to opportunistic infections. These infections cause conditions such as weight loss, fever and diarrhoea — conditions that reduce a person's appetite or block the body's ability to absorb nutrients (WHO).
The body also experiences increases in metabolic demands and uses more nutrients to fight opportunistic infections. These factors cause the body to become malnourished — making the person more susceptible to further opportunistic infections and further malnourishment. This downward spiral can accelerate the development of AIDS.
The relationship between HIV/AIDS and nutrition is cyclical. If nutrition is poor, the body's ability to fight HIV and other infections is worsened. These new infections cause further malnourishment, increasing the possibility of new infections.Credit: SA National Department of Health. Source:
South African National Guidelines on Nutrition for People Living with TB, HIV/AIDS and other Chronic Debilitating Conditions
Conversely, good nutrition can improve an HIV-infected person's quality of life by:
- "improving the function of the immune system and the body’s ability to fight infection;
- extending the period from infection to the development of the AIDS disease;
- improving response to treatment; reducing time and money spent on health care;
- keeping HIV-infected people active, allowing them to take care of themselves, their family and children; and
- keeping HIV-infected people productive, able to work, grow food and contribute to the income of their families." — ( FAO and WHO)
The dietary needs of HIV-positive people are similar to those of those without HIV: "A balanced and diverse diet consisting of starchy staples (e.g., rice, maize, potato, cassava, banana, yam) with cooked legumes (e.g., beans, peas), nuts and nut butters, animal foods, fat and oil, fruits, and vegetables", according to the US Food and Nutrition Technical Assistance (FANTA) HIV/AIDS: A Guide for Nutritional Care and Support 2004.
However, an HIV-infected person needs a larger energy intake than non-infected individuals:
- to fight the HIV infection and opportunistic infections
- to compensate for nutrients which are not absorbed properly
- for extra or different metabolic demands — FANTA
The amount of extra energy needed depends on the progression of the virus. At the asymptomatic stage, an HIV-infected person should increase their energy intake by 10% over the recommended energy intake for a similar, but non-infected individual. Once showing symptoms, this should increase to 20-30%, according to FANTA.
Nutrition is also an important component of ART therapy. The Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (1.9MB) places a large emphasis on nutrition and acknowledges that adequate nutrition, appropriate micronutrient supplements and the treatment of malnutrition enhances the effect of ART treatment.
Nutrition and AIDS/ARV dissidents
The role of nutrition in the treatment of HIV/AIDS (as described in this fact sheet) must not be confused with the claims of vitamin proponents who believe nutrition by itself is an effective treatment for HIV/AIDS and that ARV drugs are highly toxic and dangerous.
The Dr Rath Health Foundation Africa and the Treatment Information Group advertise "natural health" treatment responses to the AIDS pandemic including the use of multi-vitamins. Their adverts also claim that ARV drugs are highly toxic and dangerous (see advert).
The adverts have been condemned by The South African Medical Association (source), the Southern African HIV Clinicians' Society (source), the WHO and the United Nations (source). The Advertising Standards Authority of South Africa ordered the withdrawal of some of the newspaper advertisements and fliers published by the group because they contained unsubstantiated claims.
While the WHO acknowledges that good nutrition can "help bolster the immune system, boost energy levels and maintain body weight and well-being," it cautions that "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 ART therapy, where indicated and a healthy, balanced diet."
However, Minister of Health Manto Tshabalala-Msimang has not publicly condemned Rath's activities, prompting the TAC to file court papers against the minister, Rath and some of his associates, the Medicines Control Council (MCC) and the Western Cape MEC for Health in late November (see TAC newsletter).
Minister of Health, the Medicines Control Council (MCC), the Western Cape MEC for Health, as well as pharmaceutical proprietor Matthias Rath and several of his employees and associates, including AIDS denialists Anthony Brink, David Rasnick and Sam Mhlongo
