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Since the advent of the AIDS crisis more than 25 years ago, medical science discoveries have improved health outcomes for those with HIV infection (CDC , 2009). The physiological dynamics of this disease continue to be characterized, and the nutritional consequences remain to be fully documented.
Fifteen years ago, IFT sponsored a landmark symposium on the topic, but progress in our understanding of the impact of food and health relative to HIV management has been limited since then. This year, the Centers for Disease Control and Prevention launched a new campaign to inform the public to “Act Against AIDS ,” but none of the materials or Web links addresses the importance of nutrition support or food choices.
Multiple organ systems, including gastrointestinal, immune, and excretory are involved with HIV. In addition to these compromised systems, individuals typically present lower body weight and wasting symptoms. Thus, health of these organ systems is contingent, in part, upon food quality and nutrient delivery from foods, and paramount to these foods is their safety.
Maintaining adequate numbers of functional red blood cells may reduce the incidence of opportunistic infections. A recent meta-analysis by Adetifa and Okomo (2009) indicated a dearth of adequate clinical studies and public health interventions to address iron deficiency anemia. Yet iron deficiency anemia is among the most common nutritional challenges, particularly among HIV-infected children.
Hendricks et al. (2006) noted through cluster analysis three basic dietary patterns among adult males living with HIV. Self-selected intake patterns revealed a) fast food and fruit drinks, b) fruit and vegetables, and c) low-fat dairy as dietary clusters. Each pattern poses unique nutritional challenges and certainly exacerbates the anemia associated with HIV infections. Fields-Gardner et al. (2004) noted achieving food and nutrition security to control the HIV infection is critical in managing nutrition-related complications of the disease.
Resveratrol and its analogs continue to be popular among those investigating cancer, coronary disease, and neurodegenerative conditions (Saiko et al., 2008). Some of the metabolic perturbations in these conditions are similar to those in HIV-infected individuals. For example, in vitro evidence suggests resveratrol may reduce inflammatory processes initiated by macrophages (Radkar et al., 2008) while inhibiting eosinophil activation and degranulation (Tan and Lim, 2008), a process associated with atopy (allergenic hypersensitivity). Dysfunctional B cells and an elevated IgE are typical among those with food allergies and reflect pathogenic mechanisms among individuals infected by HIV (Bowser et al., 2007). Recent in vitro investigations suggest resveratrol may suppress B cell activity and block gene expression of associated inflammatory cytokines through several proposed mechanisms (Sharma et al., 2007; Leiro et al., 2005), including down-regulation of CD28 and CD80 stimulatory molecules, and modulating NF-ΚB transcription.
Classic strategies for an HIV vaccine development have encompassed inhibition of the viral replication or the infection of cells by administration of attenuated strains using altered plasmid DNA and use of live microorganisms to elicit normal cytotoxic T lymphocyte (CTL ) response (Robina et al., 2004). Whether HIV management includes a more aggressive approach to vaccine development or more aggressive nutritional intervention,increased understanding of the biology associated with HIV infections is paramount.
Medical nutrition management is critical for those infected with HIV. During this era of HAART (highly active antiretroviral therapy), HIV-infected individuals continue to experience deterioration of organ systems and body composition, including lipodystrophy. Unfortunately, these presentations often neglect nutritional assessment that may lead to nutritional intervention. Nutritional intervention that includes maintaining body weight and more appropriate selection of foods is often omitted because of the belief that dietary modalities will only delay the progression of the disease. However, not only does proper nutritional balance enable the body to better use its natural defense mechanisms, it also supports the body’s efforts to control the stresses of the disease, therapy, and opportune infections. Thus, importantly, the role of unique foods and proper nutritional management can improve the quality of life.References cited in this article are available from the authors.
Roger Clemens, Dr.P.H.,
Scientific Advisor, ETHorn, La Mirada, Calif.
Wayne Bidlack, Ph.D.,
Professor, California State Polytechnic University, Pomona