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AIDS and Nutrition: Scene-Setter Suneetha Kadiyala RENEWAL 3 Regional Workshop 12 th March 2007

AIDS and Nutrition: Scene-Setter Suneetha Kadiyala RENEWAL 3 Regional Workshop 12 th March 2007. Why is nutrition important?. Co-existence of malnutrition and AIDS Nutrition plays an imp. role in all aspects of the disease. Risks HIV AIDS Impacts

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AIDS and Nutrition: Scene-Setter Suneetha Kadiyala RENEWAL 3 Regional Workshop 12 th March 2007

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  1. AIDS and Nutrition: Scene-Setter Suneetha Kadiyala RENEWAL 3 Regional Workshop 12th March 2007

  2. Why is nutrition important? • Co-existence of malnutrition and AIDS • Nutrition plays an imp. role in all aspects of the disease Risks HIV AIDS Impacts Prevention Care & treatment Mitigation

  3. Outline • What is the role of nutrition in research and programming? • What are the evidence gaps? • What is the role for RENEWAL? • Highlight the potential collaborations in R3

  4. Nutrition and HIV transmission: Adult to Adult • Micronutrient deficiencies have been associatedwith increased risk of HIV transmission in observational studies • Malnutrition may increase genital ulcers and HSV shedding • May increase HIV-shedding increasing infectivity • Conflicting results even in observational studies Evidence Gap • How does pre-existing malnutrition affect susceptibility to HIV and HIV infectivity?

  5. Nutrition and HIV transmission: MTCT • Micronutrient supplementation lowered the risk of MTCT only through breast feeding among highly immuno-compromised women Evidence Gap • To what extent does adequate nutrition before pregnancy lower MTCT rates and improve pregnancy and birth outcomes among HIV positive women?

  6. Nutrition and HIV Progression • Predictive link between losses in weight, fat-free mass, and body cell mass, and fat mass and adverse clinical outcomes • Conflicting results from micronutrient studies • No effect of MN supplem. on outcomes in Zambia • MN supplem. resulted in lower death rates in Thailand • The effect of a given micronutrient intervention will depend on the background dietary status and intake in the study population. • Most studies are from the developed countries

  7. Nutrition and HIV Progression Evidence gaps • Most studies to date have examined the effect of single and in some cases multiple micronutrient status on disease progression. • Does a balanced diet improve clinical outcomes among those living with HIV in a chronically food insecure context? • Which food and nutrition security programs are effective in improving the dietary intake of those infected and affected by HIV? • What is the relative impact of such interventions on delaying ART initiation? • What are the best nutritional indicators for monitoring the clinical response of PLWH to such interventions?

  8. Nutrition and ART • Interactions between ARVs, food and nutrition can influence: • drug efficacy, toxicity, adherence to drug regimens • Metabolic complications and nutritional status Evidence Gaps: • To what extent does adequate nutrition (micro/macro) complement ART in disease progression? • How does nutrition security affect ARV adherence? • What is the impact of ARVs on nutritional status (metabolic complications, changes in body composition etc) among the food insecure? • And how does this affect their clinical outcomes ?

  9. Household nutrition security and AIDS • Convincing evidence on how adult ill-health & death affect HH food & nutrition security Evidence Gaps: • What are the intra household food distribution and nutrition outcomes (beyond children)? • Implications for high risk behaviors • What is the impact of ART on food and nutrition security of other household members? • To what extent do food and nutrition security interventions complement ART in improving dietary intake and nutrition status of other household members?

  10. Operational Questions • Food aid is the most common ‘food & nutrition’ related intervention • What long term options exist for ensuring and sustaining nutrition security within affected households and communities? • What are the feasible eligibility and exit guidelines for initiating and transitioning from nutrition support? • Developing valid, but generally applicable M&E indicators • What is the cost-effectiveness of alternate nutrition interventions to PLWHs and their households • what are the implications for scaling up such interventions?

  11. Potential Collaborations • TASO • University of Illinois (Paul McNamara) • AMPATH • Kaunda Foundation • Project Concern International

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