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Nutrition and pharmacology: general principles and implications for HIV1234

Raiten, Daniel J
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Food and nutrition play an intimate and inextricable role in all aspects of drug metabolism, safety, and effectiveness. Antiretroviral therapies (ART) have assumed a preeminent position in the prevention, care, and treatment of HIV and its comorbidities. The interaction between food, nutrition, and ART has become an expanding area of interest both in terms of clinical standards of care and as a target for research. Since the original review of this topic by the WHO in 2005, much has been learned (8). This article contains a review of what is known about the general relationships between nutrition and pharmacology, as well as issues specific to ART, with particular attention to their use in low- and middle-resource settings. The importance of food and nutrition on the bioavailability of drugs and vice versa has been an area of historical interest. However, much has been learned about the importance of nutritional status on drug metabolism, distribution, and effectiveness. The impact of traditional therapies (herbal/botanical) is highlighted as an area of clinical concern and one in need of further research. Additional attention is focused on the impact of individual micronutrients on drug pharmacokinetics and pharmacodynamics. Finally...

Executive summary—Nutritional Care of HIV-Infected Adolescents and Adults, including Pregnant and Lactating Women: What Do We Know, What Can We Do, and Where Do We Go from Here?12

Raiten, Daniel J; Mulligan, Kathleen; Papathakis, Peggy; Wanke, Christine
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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The HIV pandemic continues to place an unbearable burden on the international community, with disease prevalence remaining highest in resource-limited settings in Africa, Asia, and the Americas. HIV is most often imposed on conditions of food insecurity and consequent malnutrition, poor sanitation, and chronic exposure to a myriad of infectious (eg, malaria, tuberculosis, and diarrheal) and noncommunicable (eg, obesity, diabetes, cancer, and cardiovascular) diseases. Women and children continue to bear the greatest burden. Two essential tenets underpin our approach to HIV: 1) antiretroviral drugs (ARVs) are essential to prolong lives and to halt the spread of HIV and AIDS and 2) food and sound nutrition are essential to human health. The challenge is to apply sound principles of clinical care and nutrition science to the safe and efficacious implementation of ARVs and for long-term care for people living with HIV and AIDS. The WHO has played a leading role in developing guidelines to support this goal with the generation of general recommendations regarding nutritional needs of people living with HIV and AIDS and specific guidelines for the nutritional care of HIV-infected infants and children (<14 y of age). These proceedings represent a summary of the work accomplished at a workshop sponsored by the NIH to review the existing evidence to support changes in the recommendations regarding nutrient requirements for people living with HIV and AIDS; to support development of new WHO guidelines for adolescents and adults...

Energy expenditure in HIV infection123

Kosmiski, Lisa
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Energy intake recommendations for adults should be based preferably on direct measurements of total daily energy expenditure (TDEE) in corresponding populations who are maintaining healthy body weight and satisfactory physical activity levels. During adolescence, pregnancy, and lactation, energy requirements should be based on TDEE plus the additional energy required to advance these physiologic states. With illness, energy expenditure and energy intake change, but nutritional intervention is not necessarily beneficial. This article reviews data on energy expenditure in HIV infection with a focus on adults, adolescents aged ≥14 y, and pregnant and lactating women. Resting energy expenditure (REE) in adults with untreated asymptomatic HIV is ∼10% higher than in healthy control subjects. In asymptomatic adults receiving antiretroviral therapy, REE may be similarly increased. HIV wasting and secondary infections are also associated with increased REE. In contrast, TDEE is typically normal in asymptomatic HIV and decreased in HIV wasting and secondary infection. No direct measurements of REE or TDEE are available in adolescents or in pregnant or lactating women with HIV. On the basis of current data, energy intake may need to increase by ∼10% in adults with asymptomatic HIV to maintain body weight. In adolescents and in pregnant and lactating women with asymptomatic HIV...

Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations?1234

Forrester, Janet E; Sztam, Kevin A
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A...

Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings—insights from South Africa1234

Levitt, Naomi S; Steyn, Krisela; Dave, Joel; Bradshaw, Debbie
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery.

Nutrition and disease progression pre–highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART?1234

Chandrasekhar, Aditya; Gupta, Amita
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Several studies have investigated a variety of nutritional supplementation interventions in adults with HIV. In this narrative review, we summarize the evidence from 31 clinical trials that explore clinical benefits of macronutrient and micronutrient supplementation in this population while attempting to answer the question of whether good nutrition can delay the time to highly active antiretroviral therapy (HAART) initiation and response. We focused on trials published in English between 1990 and 2010 that reported on CD4 count, viral load, and disease progression or survival. Among 9 macronutrient and 22 micronutrient trials, we found that evidence for improved CD4 count and HIV viral load with nutritional supplementation was limited; only 11.1% and 36.8% of macronutrient and micronutrient supplementation trials, respectively, reported improved CD4 count; and 33.3% and 12.5% of macronutrient and micronutrient trials, respectively, reported decreased viral load. Given their utility as surrogate markers of HIV disease progression, this suggests limited evidence for nutritional interventions having an impact on delaying HAART initiation or on improving HAART response. However, there are challenges in evaluating the effects of nutritional supplementation on clinical disease in that comparisons are difficult due to heterogeneity in study design...

Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings1234

Musoke, Philippa M; Fergusson, Pamela
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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More than 2 million children globally are living with HIV infection and >90% of these reside in sub-Saharan Africa. Severe acute malnutrition (SAM) remains a major problem for HIV-infected children who live in resource-limited settings (RLS), and SAM is an important risk factor for mortality. SAM in HIV-infected children is associated with complications including electrolyte disorders, micronutrient deficiencies, and severe infections, which contribute to the high mortality. Access to antiretroviral therapy (ART) has significantly improved the survival of HIV-infected children, although the response to ART of children with SAM remains undocumented in the literature. Immune and virologic responses to ART in RLS are similar to those of infected children in resource-rich settings, but delays in initiation of therapy have led to a high early mortality. Antiretroviral drug toxicities have been described in children who receive therapy and may affect their quality of life and long-term survival. Metabolic complications of ART include lipodystrophy, dyslipidemia, lactic acidosis, insulin resistance, and osteopenia. These complications have been well described in adults and children from developed countries, but data from RLS are limited, and these complications may be compounded by SAM. In this article we review the epidemiology...

Nutritional and metabolic correlates of cardiovascular and bone disease in HIV-infected patients1234

Fitch, Kathleen; Grinspoon, Steven
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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The treatment of HIV infection has dramatically reduced the incidence of AIDS-related illnesses. At the same time, non-AIDS-related illnesses such as cardiovascular and bone disease are becoming more prevalent in this population. The mechanisms of these illnesses are complex and are related in part to the HIV virus, antiretroviral medications prescribed for HIV infection, traditional risk factors exacerbated by HIV, and lifestyle and nutritional factors. Further prospective research is needed to clarify the mechanisms by which HIV, antiretroviral medications, and nutritional abnormalities contribute to bone and cardiovascular disease in the HIV population. Increasingly, it is being recognized that optimizing the treatment of HIV infection to improve immune function and reduce viral load may also benefit the development of non-AIDS-related illnesses such as cardiovascular and bone disease.

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS1234

Weiser, Sheri D; Young, Sera L; Cohen, Craig R; Kushel, Margot B; Tsai, Alexander C; Tien, Phyllis C; Hatcher, Abigail M; Frongillo, Edward A; Bangsberg, David R
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways...

Food insecurity: special considerations for women1234

Ivers, Louise C; Cullen, Kimberly A
Fonte: American Society for Nutrition Publicador: American Society for Nutrition
Tipo: Artigo de Revista Científica
Português
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Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Food insecurity is the converse state, is often associated with poverty and low income, and has important implications for the health and nutrition of individuals. Given their contribution to food production and preparation, their role in society as child bearers and caregivers, the increasing number of female-headed households worldwide, and their disproportionately poor economic status, women need special consideration in discussions of food insecurity and its effect on health, nutrition, and behavior. This article reviews the scientific literature on issues related to women and food insecurity. Food insecurity is associated with obesity, anxiety, and depressive symptoms; risky sexual behavior; poor coping strategies; and negative pregnancy outcomes in women, although evidence about the direction and causality of associations is unclear. There is a lack of evidence and understanding of the effects of food insecurity in resource-poor settings, including its effect on weight, nutritional outcomes, and pregnancy outcomes...