Nutritional and Health-Related Environmental Studies (NAHRES)

Nutrition and HIV/AIDS: The efficacy of food based nutrition interventions evaluated by stable isotope techniques

Background

Out of the more than 40 million people living with HIV/AIDS worldwide, nearly 30 million individuals are living in sub-Saharan Africa. The highest infection rates worldwide are found in southern Africa where the prevalence of HIV infection in adults exceeds 25 % in most countries. The extremely high prevalence of HIV/AIDS combined with food shortages and high prevalence of undernutrition highlight the current crisis in sub-Saharan Africa. Many African governments are currently grappling with policy and programme challenges related to food, nutrition and HIV/AIDS. Due to the urgent need to formulate evidence-based recommendations, the World Health Organization recently undertook a review of nutrition and HIV/AIDS under the direction of the WHO Technical Advisory Group on Nutrition and HIV/AIDS. The review was presented and discussed during a WHO consultation in Durban, South Africa (April 10-13, 2005) and resulted in a report (EB116/12) presented to the 116th WHO Executive Board, May 26-28, 2005.

The interactions between nutrition and HIV/AIDS are complex as HIV infection progressively weakens the immune system and also because undernutrition per se may increase the susceptibility to the infection. In many areas, undernutrition and HIV infection overlap, both in terms of protein-energy malnutrition (Hsu et al 2005) and micronutrient deficiencies (Friis 2005). It is important to note that HIV infected individuals have increased energy requirements and the importance of access to an adequate diet and to integrate nutrition into a comprehensive response to HIV/AIDS can therefore not be overestimated. In particular, as antiretroviral (ARV) treatment becomes readily available in resource poor areas, the associations between nutrition - HIV/AIDS - ARV treatment need special attention (Raiten, Grinspoon & Arpadi 2005). The life-saving benefits of ARV treatment have been well established, however, to achieve the full benefits of ARV treatment, adequate dietary intake is essential. Very limited information is available on the interactions between ARV treatment and nutrition, in particular in chronically undernourished populations, severely malnourished children and pregnant and lactating women. There is an urgent need to evaluate the efficacy of locally appropriate, sustainable food based strategies on nutritional status and on the potential impact of improved nutritional status on delaying the initiation of ARV treatment and/or on the response to ARV treatment. The importance of including measures of body composition was clearly identified as a priority area during the consultation in Durban as, in particular, changes in fat deposition have been reported in individuals on ARV treatment (Grinspoon & Carr 2005).

Infants and children are especially vulnerable as HIV-infection impairs growth early in life (Arpadi 2005). The etiology of growth faltering is often multifactorial and include insufficient food intake as well as frequent episodes of diarrheal disease and other opportunistic infections. WHO/UNICEF recommend that HIV-infected women avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Unfortunately, these conditions are not easily met for the majority of women in resource poor areas. The urgent need to develop and evaluate strategies to meet the nutritional needs of infants and young children who are no longer breastfed is thus a major challenge in many settings (Saadeh, Henderson & Vallenas 2005).


Overall objective
  • To contribute to a better understanding of the importance of adequate nutrition for people living with HIV/AIDS

Specific objectives
  • To evaluate the efficacy of food based nutrition interventions in people living with HIV/AIDS based on changes in body composition (muscle mass), measured by stable isotope technique
  • To evaluate associations between nutrition - HIV infection - ARV treatment whenever appropriate

Expected research outputs
  • New data on the efficacy of food based nutrition interventions in people living with HIV/AIDS
  • New data on the associations between nutrition - HIV infection – ARV treatment

Proposal submission forms

Research institutions in Member States interested in participating in this CRP are invited to submit proposals, using the standard forms, directly to the Research Contracts Administration Section (NACA) of the International Atomic Energy Agency: Official.Mail@iaea.org or to Ms. Lena Davidsson: L.Davidsson@iaea.org.

For more information about research contracts and research agreements, please visit our web-site.


Deadline for submission of proposals

Proposals must be received by the contract administration section or Ms. Lena Davidsson no later than November 1, 2005. Transmission via E-mail is acceptable if all required signatures are scanned.

For additional information, please contact:
Lena Davidsson
Section Head
Nutritional and Health Related Environmental Studies Section
Division of Human Health
International Atomic Energy Agency (IAEA)
Wagramer Strasse 5
A-1400 Vienna
Austria

Phone: + 43 1 2600 21657 or 21674
Fax: + 43 1 26007


References
  1. Arpadi S. Growth failure in HIV-infected children. Background paper No. 4. Consultation on nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 10-13, 2005 (in press)
  2. Friis H. Micronutrients and HIV infection: A review of current evidence. Background paper No. 2. Consultation on nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 10-13, 2005 (in press)
  3. Grinspoon S, Carr A. Cardiovascular risk and body fat abnormalities in HIV-infected adults. N Engl J Med 2005:352:48-62
  4. Hsu J W-C, Pencharz PB, Macallan D, Tomkins A. Macronutrients and HIV/AIDS: A review of current evidence. Background paper No. 1. Consultation on nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 10-13, 2005 (in press)
  5. Raiten DJ, Grinspoon S, Arpadi S. Nutritional considerations in the use of ART in resource-limited settings. Background paper No. 6. Consultation on nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 10-13, 2005 (in press)
  6. Saadeh RJ, Henderson P, Vallenas C. Infant feeding and HIV transmission. Background paper No. 5. Consultation on nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 10-13, 2005 (in press)
  7. Schoeller DA. Hydrometry. In: Human body composition (Roche AF, Heymsfield SB, Lohman TG, eds). Human Kinetics, Champaigne, IL, 2004, pp 25-43
  8. World Health Organization. Nutrition and HIV/AIDS. EB116/12.