Effects of HIV on nutrition

Body changes

A man suffering wasting related to HIV and TB infection

AIDS is well known for causing severe weight loss known as wasting. In Africa, the illness was at first called “slim” because sufferers became like skeletons. Yet body changes are not only seen during AIDS; less dramatic changes often occur in earlier stages of HIV infection.
Whereas starving people tend to lose fat first, the weight lost during HIV infection tends to be in the form of lean tissue, such as muscle. This means there may be changes in the makeup of the body even if the overall weight stays the same.¹
In children, HIV is frequently linked to growth failure. One large European study found thatchildren with HIV were on average around 7 kg (15 lbs) lighter and 7.5 cm (3 inches) shorter than uninfected children at ten years old.²

What causes these changes?

One factor behind HIV-related weight loss is increased energy expenditure. Though no one knows quite why, many studies have found that people with HIV tend to burn around 10% more calories while resting, compared to those who are uninfected. People with advanced infection or AIDS (particularly children) may expend far more energy.³
But faster metabolism is not the only problem. In normal circumstances, a small rise in energy expenditure may be offset by eating slightly more food⁴ or taking less exercise.⁵ There are two other important reasons why people with HIV may lose weight or suffer childhood growth failure.⁶
The first factor is decreased energy intake or, to put it simply, eating less food. Once HIV has weakened the immune system, various infections can take hold, some of which can affect appetite and ability to eat. For example, sores in the mouth or throat may cause pain when swallowing, while diarrhoea or nausea may disturb normal eating patterns. Someone who is ill may be less able to earn money, shop for food or prepare meals. Stress and psychological issues may also contribute.
Secondly, weight loss or growth failure can occur when the body is less able to absorb nutrients – particularly fat – from food, because HIV or another infection (such as cryptosporidium) has damaged the lining of the gut. Diarrhoea is a common symptom of such malabsorption.

Prevention of HIV transmission from mother to child

What is mother-to-child transmission?

Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding.¹

Is MTCT a major problem?

In 2008, around 430,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival.²
In high income countries MTCT has been virtually eliminated thanks to effective voluntary testing and counselling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year.

How can MTCT be prevented (PMTCT)?

An HIV positive mother and her HIV positive baby in India

Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy.^{3 4}

• Preventing HIV infection among prospective parents - making HIV testing and other prevention interventions available in services related to sexual health such as antenatal and postpartum care.
• Avoiding unwanted pregnancies among HIV positive women - providing appropriate counseling and support to women living with HIV to enable them to make informed decisions about their reproductive lives.
• Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
• Integration of HIV care, treatment and support for women found to be positive and their families.

The last of these can be achieved by the use of antiretroviral drugs, safer infant feeding practices and other interventions.

Worldwide statistics commentary

Number of people living with HIV

According to estimates from the UNAIDS 2009 AIDS Epidemic Update, around 31.3 million adults and 2.1 million children were living with HIV at the end of 2008.

Number of people infected during 2008, and the number of deaths

During 2008, some 2.7 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS.
The year also saw 2 million deaths from AIDS - a high global total, despite antiretroviral (ARV) therapy, which reduced AIDS-related deaths among those who received it. The number of deaths probably peaked around 2004, and has since declined only slightly.

How people become infected with HIV

Globally, around 11% of HIV infections are among babies who acquire the virus from their mothers; 10% result from injecting drug use; 5-10% are due to sex between men; and 5-10% occur in healthcare settings. Sex between men and women accounts for the remaining proportion – around two thirds of new infections.

HIV/AIDS Statistics - Worldwide

The latest statistics of the global HIV and AIDS were published by UNAIDS in November 2009, and refer to the end of 2008.

	Estimate	Range
People living with HIV/AIDS in 2008	33.4 million	31.1-35.8 million
Adults living with HIV/AIDS in 2008	31.3 million	29.2-33.7 million
Women living with HIV/AIDS in 2008	15.7 million	14.2-17.2 million
Children living with HIV/AIDS in 2008	2.1 million	1.2-2.9 million
People newly infected with HIV in 2008	2.7 million	2.4-3.0 million
Children newly infected with HIV in 2008	0.43 million	0.24-0.61 million
AIDS deaths in 2008	2.0 million	1.7-2.4 million
Child AIDS deaths in 2008	0.28 million	0.15-0.41 million

More than 25 million people have died of AIDS since 1981.