Nutrition in the Context of HIV/AIDS
Nutrition for People Living with HIV/AIDS
Nutrition Requirements for People Living with HIV/AIDS
(Information below is based on WHO Technical Consultation 2003)
Energy requirements at a glance
- Energy requirements are likely to increase by 10% to maintain body weight and physical activity in asymptomatic HIV-infected adults, and growth in asymptomatic children.
- During symptomatic HIV, and subsequently during AIDS, energy requirements increase by approximately 20% to 30% to maintain adult body weight.
- Energy intakes need to be increased by 50% to 100% over normal requirements in children experiencing weight loss.
Adults: Studies point to low energy intake combined with increased energy demands due to HIV infection and related infections as the major driving forces behind HIV-related weight loss and wasting.
- Increased energy intake by 10% to maintain body weight in asymptomatic HIV-infected adults.
- Increased energy intake by 20% to 30% for adults during periods of symptomatic disease or opportunistic infection. NOTE: This increase may not be feasible during periods of acute infections or illness and might not be necessary due to reduced physical activity.
- Increased energy intake by 30% during the recovery period. NOTE: Efforts should be made to aim at the maximum achievable to compensate for losses during periods of infections and illness.
Maintaining physical activity is highly desirable for preserving quality of life and maintaining muscle tissue.
Children: Energy requirements in children can vary according to the type and duration of HIV-related infections and whether there is weight loss along with acute infection.
- Increased energy intake by 10% to maintain growth in asymptomatic HIV-infected children
- Increased energy intake by 50% to 100% for HIV-infected children experiencing weight loss over established requirements for otherwise healthy uninfected children
Pregnant and lactating women: The suggested energy intake for HIV-infected adults should also apply to pregnant and lactating HIV-infected women until updated evidence-based recommendations are provided.
Protein: There is insufficient data at present to support an increase in protein intake for PLWHA above normal requirements for health i.e. 12% to 15% of total energy intake.
Fat: There is no evidence that total fat needs are increased beyond normal requirements as a consequence of HIV infection.
However, special advice regarding fat intake might be required for individuals undergoing antiretroviral therapy or experiencing persistent diarrhoea.
Micronutrients requirements at a glance
- To ensure micronutrient intakes at Recommended Daily Amount (RDA) levels, HIV-infected adults and children are encouraged to consume healthy diets including vegetables and/or fruits.
- Nevertheless, dietary intake of micronutrients at RDA levels may not be sufficient to correct nutritional deficiencies in HIV-infected individuals.
- There is evidence that some micronutrient supplements, e.g. vitamin A, zinc and iron can produce adverse outcomes in HIV-infected populations.
Adults: HIV-infected adults and children should consume diets that ensure micronutrient intakes at RDA levels. However, this may not be sufficient to correct nutritional deficiencies in HIV infected individuals.
Results from several studies raise concerns that some micronutrient supplements, e.g. vitamin A, zinc and iron, can produce adverse outcomes in HIV-infected populations. Safe upper limits for daily micronutrient intakes for PLWHA still need to be established.
Children: In keeping with WHO recommendations, 6 to 59-month-old children born to HIV-infected mothers living in resource-limited settings should receive vitamin A supplements every six months (100,000 IU for infants 6 to 12 months and 200,000 IU for children >12).
Pregnant and lactating women - Iron-folate supplementation: In keeping with WHO recommendations, HIV-infected women should receive daily iron-folate supplementation (400 µg of folate and 60 mg of iron) during six months of pregnancy to prevent anaemia and twice-daily supplements to treat severe anaemia.
However, in view of iron's potential adverse effects (due to its pro-oxidant activity which might accelerate disease progression) research on the safety of iron supplementation in adults and children with HIV infection is recommended.
Vitamin A: In keeping with WHO recommendations for areas of endemic vitamin A deficiency, HIV-infected women should receive a single high-dose of vitamin A (200,000 IU) as soon as possible after delivery, but no later than six weeks after delivery.
Research is currently under way to further assess the effect of single dose, postpartum vitamin A supplementation on HIV-infected women.
Multiple micronutrient supplements: Micronutrient deficiencies are common in resource-limited settings where HIV infection is prevalent. Some studies show that different multiple micronutrient supplements may have produced a broad range of beneficial outcomes.
Pending additional information, micronutrient intakes at the RDA level are recommended for HIV-infected women during pregnancy and lactation.
Nutrition and antiretroviral therapy
ART is an essential component of care for PLWHA but there are a number of metabolic complications associated with the use of certain treatments.
Nutritional interventions should be an integral part of all HIV treatment programs so that improved diet may enhance ART acceptability, adherence and effectiveness.
View Recommended daily caloric intakes
6 March, 2016