World Health Organisation conference on Nutrition, ICC Durban South Africa
WHO
2005-04-22
HIV/AIDS is affecting more people in eastern and southern Africa than our fragile health systems can treat, demoralizing more children than our educational systems can inspire, creating more orphans than communities can care for, wasting families and threatening our food systems.
The HIV/AIDS epidemic is increasingly driven by
and contributes to factors that also create malnutrition - in particular,
poverty, emergencies and inequalities.In
urgent response to this situation, we call for the integration of nutrition into
the essential package of care, treatment and support for people living with
HIV/AIDS and efforts to prevent infection.
We recognize that,
1. Far reaching steps need to be taken to
reverse the current trends in malnutrition, HIV-infection and food insecurity in
most countries in the region, in order to achieve the Millennium Development
Goals .
2. Adequate nutrition cannot cure HIV infection
but it is essential to maintain the immune system and physical activity, and to
achieve optimal quality of life.
3. Adequate nutrition is required to optimize
the benefits of antiretroviral drugs (ARVs), which are essential to prolong the
lives of HIV-infected people and prevent HIV transmission from mother-to-child.
4. There is a proliferation in the marketplace
of untested diets and dietary therapies, which exploit fears, raise false hopes
and further impoverish those infected and affected by HIV and AIDS.
5. Exceptional measures are needed to ensure the
health and well-being of all children affected and made vulnerable by HIV/AIDS.
Young girls are especially at risk.
6. Knowledge of HIV status is important to
inform reproductive health and child feeding choices.
Conclusions
This consultation reviewed the scientific
evidence and discussed the programmatic experience on nutrition and HIV/AIDS and
has come to the following conclusions:
Macronutrients
* HIV-infected adults and children have
increased energy needs compared with uninfected adults and children. Energy
needs increase by 10 percent in asymptomatic HIV-infected adults and children.
Energy needs for adults suffering from more advanced disease are increased by 20
to 30%. In HIV-infected children experiencing weight loss, energy needs are
increased by 50 to 100%.
* There is no evidence for an increased need for
protein intake of people infected by HIV/AIDS over and above that required in a
balanced diet to satisfy energy needs (12 to 15% of total energy intake).
* Loss of appetite and poor dietary intake are
important causes of weight loss associated with HIV infection. Effective ways of
improving dietary intakes need development and documentation.
Micronutrients
* Micronutrient deficiencies are frequently
present in HIV-infected adults and children.
* Micronutrient intakes at daily recommended
levels need to be assured in HIV-infected adults and children through
consumption of diversified diets, fortified foods, and micronutrient
supplementation as needed.
* WHO recommendations on vitamin A, zinc, iron,
folate and multiple micronutrient supplements remain the same.
* Micronutrient supplements are not an
alternative to comprehensive HIV treatment including ARV therapy.
* Studies have shown that some micronutrient
supplements may prevent HIV disease progression and adverse pregnancy outcomes.
Additional research is urgently required.
Pregnancy and Lactation
* Pregnancy and lactation do not hasten the
progression of HIV infection to AIDS.
* Optimal nutrition of HIV-infected mothers
during pregnancy and lactation increases weight gain, and improves pregnancy and
birth outcomes.
* HIV-infected pregnant women gain less weight
and experience more frequent micronutrient deficiencies.
Growth
* HIV infection impairs the growth of children
early in life. Growth faltering is often observed even before the onset of
symptomatic HIV infection.
Poor growth is associated with increased risk of
mortality.
* Viral load, chronic diarrhoea and other
opportunistic infections impair growth in HIV-infected children. The growth and
survival of HIV-infected children is improved by prophylactic cotrimoxazole, ARV
therapy and the early prevention and treatment of opportunistic infections.
* Improved dietary intake is essential to enable
children to regain lost weight after opportunistic infection.
Infant and Young Child Feeding
* For HIV-uninfected mothers and mothers who do
not know their HIV status, exclusive breastfeeding for six months is the ideal
practice because of its benefits for improved growth, development and reduced
childhood infections. Safe and appropriate complementary feeding and continued
breastfeeding for 24 months and beyond is recommended.
* The risk of HIV transmission through
breastmilk is constant throughout the period of breastfeeding and is greatest
among women newly infected or with advanced disease.
* Studies further support that exclusive
breastfeeding is associated with less HIV transmission than mixed breastfeeding.
* WHO/UNICEF recommend that HIV-infected mothers
avoid breastfeeding when replacement feeding is acceptable, feasible,
affordable, sustainable and safe. However these conditions are not easily met
for the majority of mothers in the region.
* Evidence shows that safer infant feeding can
be achieved with adequate support, however health systems and communities are
not providing this support to make infant feeding safer.
* Early breastfeeding cessation is recommended
for HIV-infected mothers and their infants. The age for breastfeeding cessation
depends on the individual circumstances of mothers and their infants. The
consequences of this on transmission, mortality, growth and development need to
be urgently studied. There is an immediate need to evaluate suitable ways of
meeting nutritional needs of infants and young children who are no longer
breastfed.
Nutrition and ARV interaction
* The life-saving benefits of ARVs are clearly
recognized. To achieve the full benefits of ARVs, adequate dietary intake is
essential.
* Dietary and nutritional assessment is an
essential part of comprehensive HIV care both before and during ARV treatment.
* Long term use of ARVs can be associated with
metabolic complications (cardiovascular disease, diabetes and bone related
problems). The value of ARV therapy far outweighs the risks and the metabolic
complications need to be adequately managed. The challenge is how best to apply
that extensive clinical experience in managing these types of metabolic
disorders in HIV infected adults and children in Africa.
* Interactions between nutrition and ARVs in
chronically malnourished populations, severely malnourished children, and
pregnant and lactating women need to be investigated.
* The effects of traditional remedies and
dietary supplements on the safety and efficacy of ARV drugs need to be
evaluated.
Recommendations for Action
Based on these conclusions all concerned parties
are urged to make nutrition an integral part of their response to the challenges
of the HIV/AIDS pandemic and the following recommendations are made for
immediate implementation at all levels:
1. Strengthen political commitment and improve
the positioning of nutrition in national policies and programmes.
* Use existing and develop new advocacy tools to
sensitize decisionmakers about the urgency of the problem, the impact on
development targets and the opportunity to improve care.
* Advocate for increased resource allocation and
support for improved nutrition, in general, and for addressing the nutritional
needs of HIVaffected and infected populations.
* Prioritize the needs of children affected and
made vulnerable by HIV/AIDS.
* Clarify and improve multisectoral
collaboration and coordination between agriculture, health, social services,
education and nutrition.
2. Develop practical nutrition assessment tools
and guidelines for home, community, health facility-based and emergency
programmes
* Validate simple tools to assess diet and
supplement use including traditional and alternative therapies, nutritional
status, and food security so that nutrition support provided within HIV
programmes is appropriate to individual needs.
* Develop standard and specific guidelines for
nutritional care of individuals, and implementation of programmes at
health-facility and community levels.
* Review and update existing guidelines to
include nutrition/HIV considerations (e.g., integrated management of adolescent
and adult illness, ARV treatment, nutrition in emergencies).
3. Scale-up existing interventions for improving
nutrition in the context of HIV
* Accelerate the implementation of the Global
Strategy for Infant and Young Child Feeding.
* Renew support for the Baby-friendly Hospital
Initiative.
* Accelerate the fortification of staple foods
with essential micronutrients.
* Implement WHO protocols for vitamin A, iron,
folate, zinc, multiple micronutrient supplementation and management of severe
malnutrition.
* Accelerate training and use of guidelines and
tools for infant feeding counselling and maternal nutrition in prevention of
mother-to-child transmission programmes
* Expand access to HIV counselling and testing
so that individuals can make informed decisions and receive appropriate advice
and support on nutrition, including in emergency settings.
4. Conduct systematic operational and clinical
research to support evidence-based programming
* Develop and implement operational and clinical
research to identify effective interventions and strategies for improving
nutrition of HIVinfected and affected adults and children.
* Document and publish results and ensure access
to lessons learned at all levels.
* Encourage scientific journals to give greater
opportunity for publication of operational research and records of good
practice.
5. Strengthen, develop and protect human
capacity and skills.
* Include funding for nutrition capacity
development in HIV scale-up plans.
* Incorporate nutrition into training, including
pre-service training, of health, community and home-based care workers. Specific
skills such as nutritional assessment and counselling, and programme monitoring
and evaluation should be included. Such training should be not favour particular
commercial interests.
* Strengthen the capacity of government and
civil society to develop and monitor regulatory systems to prevent commercial
marketing of untested diets, remedies, and therapies for HIV-infected adults and
children.
* Improve the conditions of service and coverage
of health workers, especially dieticians and nutritionists, to deliver
nutritional services.
* Identify and utilize local expertise to
improve response to emergency conditions.
6. Incorporate nutrition indicators into
HIV/AIDS monitoring and evaluation plans
*Include appropriate nutrition process and
impact indicators for clinical and community surveillance, and for national,
regional, and international progress reporting.
(Source: WHO, April 21, 2005)
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(2002-12-09)
Women, Children and HIV
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(2008-02-14)
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