HIV and Nutrition知识讲稿.ppt

ESTIMATED PROBABILITIES OF HIV INFECTION BY TREATMENT GP. SOUTH AFRICAN VITAMIN A STUDY [N=630] HIV transmission (KM analysis estimate) Vitamin A % Placebo % RR (95%CI) At 1 day 7.2 6.1 At 1 month 12.0 16.1 At 3 months 20.3 22.3 0.91 (0.67-1.24)* * Estimated with the delta-method approximation from reported proportions and 95% CI’s in Coutsoudis AIDS 1999;13:1517 HIV and Nutrition Nigel Rollins Department of Paediatrics and Child Health Household-level labour shortages are attributable to adult morbidity and mortality as is the rise in number of dependants Contest: Projections do not suggest demographic effect of HIV/AIDS on changes in dependency But these do not consider: Cluster effects at the level of the household Age and sex distribution of population affected by HIV Non-productivity of sick adults Loss of assets and skills Skills are lost not just in the labour market but also in the home. Food security, preparation and coping strategies The burden of care Sick adults and of orphans Major expenditure Diversion of resources and labour Malnutrition and HIV “Undernourished individuals are more susceptible to being infected with HIV and for transmission” ? “Malnutrition thus threatens to accelerate progression from HIV to AIDS for millions of individuals” ? “This fact implies that plans for introduction of ARV Rx. on a large scale should be combined with nutritional support programmes.” Other influences Various guidelines emerging Some recommending up to 100% extra protein Opportunistic market Ipap; Moducare; Extra virgin olive oil ARVs No comment in WHO draft guidelines on ARVs in developing countries What is known? Growth and HIV Energy expenditure / why wasting Interventions Micronutrients Transmission Disease progression Energy expenditure Resting energy expenditure (REE) Basal metabolic rate (BMR) Total energy expenditure (TEE) Exercise and additional me