Malnutrition and HIV Infection

Malnutrition and the human immunodeficiency virus (HIV) infection usually overlap in adults and children. The probability of HIV infection among malnourished children is much higher than in the general population. In Africa, for example, between 12% and 25% of clinically malnourished children are infected with HIV (1-5), in contrast to about 1% in the general population (1). Micronutrient deficiency is also common in HIV infection. Deficiencies of vitamins A, B, C, and E are more prevalent among children and adults infected with HIV than in HIV-negative individuals (6-9). In these studies, HIV status as well as anthropometric or vitamin status were assessed cross sectionally. This type of study is limited by the difficulty of determining the temporal relationship between HIV infection and nutritional deficiency. HIV infection could lead to nutritional deficiency through decreased food intake, malabsorption, and increased utilization and excretion of nutrients (10). On the other hand, nutritional deficiencies may contribute to faster progression of HIV disease through an adverse impact on immune function. Longitudinal studies are better suited to examine the relations of nutritional factors and HIV infection. These are reviewed in this chapter. First, we present studies that examined how nutritional status could affect HIV-related outcomes and discuss the mechanisms associated with these relations. Next, we present data on the reverse relationship: how HIV infection affects nutritional status and the pathophysiologic mechanisms associated with it.