The infection caused by the Human Immunodeficiency virus (HIV) can progress to the symptomatic condition ‘Acquired Immunodeficiency syndrome’ (AIDS), which causes immunosuppression, high incidence of opportunistic infections (which in non-infected individuals may be harmless), malignancies (Poulia, 2010), and ultimately death, and itis currently considered one of the main causes of death worldwide (Figure 1) (Nelms, 2010).
HIV is a retrovirus that uses host’s CD4+T immune cells as factories (Figure 2) for its own replication (Nelms, 2010); this event destroys the cells and causes immunosuppression (CDC, 2011).
From a nutritional point of view, HIV/AIDS represents a great challenge because multiple factors, such as theinfection itself, disease complications, opportunistic infections and medical treatment (medication side effects and dug-nutrient interactions) can worsen the patient’s nutritional status (Nelms, 2010). These factors may cause, malnutrition, body weight loss (Poulia, 2010), AIDS-related wasting syndrome (AWS), and anemia (Nelms, 2010), among others.
HIV treatment includesantiretroviral drugs, prevention and treatment of opportunistic infections, optimization of hormonal levels, and nutritional therapy; this multifactorial approach seems to help preventing the progression of HIV to AIDS, and reducing mortality rates (Nelms, 2010).
Aetiology of the Nutritional Deficiencies
In HIV patients, malnutrition (Table 2) can be caused by: low food intake, increasedmetabolic needs, malabsorption (Poulia, 2010), and metabolic changes (Colecraft, 2008). Low food intake may be caused by oral and oesophageal sores, neurological problems, medication side-effects (e.g.: nausea, vomiting) (Poulia, 2010), and associated with low income or poverty, and deficient social support (Colecraft, 2008). Nutrient loses are directly associated with malapsorption, diarrhea, andvomiting; malabsorption may be caused by the changes of the gut lining as a response to the infection (Nelms, 2010), and can lead to reduced absorption of dietary fats and fat-soluble vitamins A and E (Semba & Tang, 1999); diarrhea and vomiting may be consequences of opportunistic infections and/or drug side-effects (e,g.: Combivir can cause nausea, vomiting, and diarrhea, among other sideeffects) (Nelms, 2010). Increased metabolic needs are consequence of the specific nutrient loses, and the associated metabolic changes and increased macro- and micronutrient requirements characteristic of this disease (Colecraft, 2008).
AIDS-related Wasting Syndrome
AIDS-related Wasting Syndrome is defined as a ‘10% weight loss without an identifiable cause that is accompanied by fever or diarrhoeafor 30 days or more’ (Nelms, 2010). This definition seems to be appropriate from an epidemiological point of view, but does not take into account malnutrition and body cell mass (BCM), so a new criteria is been established to define Wasting (Table 1); thus, clinically, involuntary and progressive loss weight of this magnitude is considered Wasting, and it represents an unwanted nutritional status(Frajardo-Rodriguez & Rivero-Vera, 2001). AWS aetiology seems to be multifactorial; the factors leading to AWS include inadequate intake, malabsorptive disorders, metabolic alterations, hypogonadism, and excessive cytokine production (Grinspoon & Mulligan, 2003). The weight loss associated with Wasting may be caused by the increased protein catabolism, and could be reflected on a decreasedBMI value. BMI values in HIV population are considered an independent predictor of survival; it is estimated that BMI values lower than 16 kg/m2 are associated with a survival of 0.8 years, whereas BMI values ≥ 22 kg/m2 may offer a survival of 8.9 years (van der Sande et al., 2004); thus, optimizing this value is key for the treatment.
HAART and its Nutritional Implications
HAART stands for...