Nutrition and immune function in human immunodeficiency virus infection

Abstract

The triad of human immunodeficiency virus (HIV) infection, nutritional status and immune function are intimately related, each factor having effects on the others. The dominant effect in this three-way relationship is the effect of HIV infection on nutritional status, an effect which, until the advent of potent anti-retroviral drugs, has been manifest primarily as wasting. Recently, more complex metabolic abnormalities have become apparent, particularly fat redistribution syndromes, hyperlipidaemia and hypercholesterolaemia. For the converse effect, the effect of nutritional state on HIV disease progression, there is good evidence that clinical outcome is poorer in individuals with compromised nutrition. However, the beneficial effects of nutritional support have been more difficult to demonstrate. For macronutrients, effective macronutrient supply improves survival in severely-malnourished individuals and may have beneficial effects in less-severely-affected individuals. Micronutrient deficiencies appear to be involved in modifying clinical HIV disease and may also be associated with enhanced mother-to-child transmission of virus, particularly in developing countries. Intervention trials in this setting are currently under way. In conclusion, the interaction of HIV infection and nutrition is of great importance not just because of the major impact that HIV infection has on nutritional state, but also because strategies to improve nutritional status, both quantitatively and qualitatively, may have a beneficial effect on the clinical and immunological course of the disease.

Assessing Nutrient Intake and Nutrient Status of HIV Seropositive Patients Attending Clinic at Chulaimbo Sub-District Hospital, Kenya

“…This may thus be viewed as a bad trend for patients with low energy intake as reported in this study. The higher energy intake assists to a certain degree in reducing wasting and improves the well-being of the patients [1]. …”

“…There exists a complex interaction between human immunodeficiency virus (HIV), infection and immune function, with a dominant effect of HIV infection on nutritional status [1]. The influence of nutrition on immune function generally shows that suboptimal nutrition results in immunological deficiencies [1].…”

“…The influence of nutrition on immune function generally shows that suboptimal nutrition results in immunological deficiencies [1]. Nutrient deficiencies cause immunosuppression and increase susceptibility to infections with a resultant loss of immune cell function which allows intrusion by several different infectious agents.…”

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

“…While the proportion of overweight/obesity is increasing in the HIV-positive population, the incidence and prevalence of diabetes also tends to increase, leading to a cycle that feeds back: diabetics gain more weight, and those who gain more weight tend to stay diabetic. Before HAART, weight loss and malnutrition were frequent, and wasting syndrome, a relatively common complication of advanced stages of HIV infection, came to be considered an AIDS-defining event from 1987 onwards 32,33 . In the United States, one of the effects of reduced morbidity following the use of antiretroviral therapy, and especially HAART, was a decline in the incidence of wasting syndrome between 1992 and 1999, with a more pronounced trend after the end of 1995 34 , which coincides with the beginning of the HAART era.…”

Increased risk of mortality and loss to follow-up among HIV-positive patients with oropharyngeal candidiasis and malnutrition before antiretroviral therapy initiation: a retrospective analysis from a large urban cohort in Johannesburg, South Africa

“…20 Malnutrition in HIV-positive patients causes severe immuno-deficiency with depletion of CD4 cells and increase in HIV viral replication, ultimately increasing susceptibility to opportunistic infections and infectious diseases. 21-23 Hence a cycle of infection, malnutrition and immuno-deficiency has been described (Figure 1). 12,13,19 …”