Download Session 7 Malnutrition and anemia

MALNUTRITION
MALNUTRITION AMONG IDUS:
BASIC FACTS
 Drug
users are at increased risk of malnutrition
regardless of whether or not they are infected with
HIV
 Specific
drugs may alter appetite, interfere with
gastrointestinal absorption, and/or have
proinflammatory responses that can lead to
disturbances in metabolic rate
 Behaviorally,
drug dependence may affect access
to food and food selection
MALNUTRITION AMONG IDUS:
BASIC FACTS

The HIV infected drug users at greater risk for malnutrition

The risk of comorbid conditions, such as hepatitis C (HCV)
and tuberculosis (TB), is increased among drug using
populations and may further affect nutritional and
metabolic status
MALNUTRITION AMONG IDUS:
BASIC FACTS
 Malnutrition
may impact the course of HIVinfection through a variety of mechanisms:

compromising host immune function

diminishing response to therapies

promoting co-morbidities
NUTRITION AMONG IDUS
 Nutritional
compromise has been a hallmark of
untreated HIV infection
 Persons
with HIV infection often have inadequate
dietary intake of calories, protein, and
micronutrients
 They
have unintentional weight loss which is a
strong predictor of mortality
NUTRITIONAL STATUS OF IDUS: INDIA

Poor nutritional status in both HIV-positive and HIV-negative
drug users

Nutritional status worse in HIV positive drug users

52% of HIV-positive drug users and 50% of HIV-negative drug
users having BMI levels below 18.5 kg/m2

HIV-positive IDUs had significantly lower levels of fat mass, fatfree mass, and percent body fat than the HIV-negative IDUs

HIV-positive IDUs had lower cholesterol levels and higher
triglycerides than HIV-negative IDUs
Tang et al, 2011
NUTRITIONAL STATUS OF IDUS: INDIA

Conditions which most certainly place HIV positive IDUs at
higher risk of continued malnutrition:

self-reported TB

diarrhea

laboratory-confirmed Hepatitis C infection among the
HIV-positive IDUs
Tang et al, 2011
SIGNIFICANCE OF IMPROVING NUTRITION
AMONG HIV POSITIVE IDUS

Emerging evidence suggests that poor nutritional status at
the start of ARV treatment is predictive of mortality

It may be important to improve nutritional status in the
HIV-positive population prior to initiation of ARV treatment
in order for patients to reap the full benefits of therapy
ANAEMIA
ANAEMIA IN DRUG USERS

Anaemia is highly prevalent among injecting drug
users, both HIV infected and HIV uninfected

Anaemia may be contributed significantly by nutritional
disorders among IDUs

Anaemia is highly correlated with frequency of
injection and it is suggested that cessation of injection
use may improve anaemia

Anaemia contributes to increased morbidity as well as
mortality
ANAEMIA IN HIV INFECTED DRUG USERS

Anemia is a common clinical finding in HIV-infected
patients and is associated with:
 advanced disease
 lower quality of life
 higher mortality

Factors contributing to the development of anemia
 nutritional deficiencies
 opportunistic infections
 AIDS-related malignancies
 drug treatment
 direct effect of HIV on the bone marrow
ANAEMIA IN HIV INFECTED DRUG USERS
 Zidovudine,
an ARV can contribute to
anaemia
 Iron
deficiency
 Inflammation-induced
 HCV
iron
iron maldistribution of iron
may possibly contribute to redistribution of
ART AND ANAEMIA

ART can improve anaemia in HIV infected drug users:
Reduction of opportunistic infections
 Reduction of associated anemia of chronic disease
 Reduction of gut abnormalities
 Improvement in micronutrient status
