AIDS: importance of nutrition confirmed

[Guest guest]

AIDS: importance of nutrition confirmed

R. PRASAD

An 18-month study on more than 10,500 people with HIV/AIDS in Tamil Nadu found

nutritional supplements improved their health

In what may be the biggest study ever conducted in India, the Tamil Nadu State

AIDS Control Society (TANSACS) has found conclusive evidence that providing

micro and macronutrients to people living with HIV/AIDS greatly improves their

health and quality of life.

The 18-month study undertaken in association with Duke University was started in

September 2005 in the State. It was undertaken in three centres, covering 10

districts, that provide anti-retroviral therapy (ART).

It involved the supply of both micro and macronutrients to people, both adults

and children, who were on ART as well as those who did not require it. The

objective was to study how nutritional supplementation helped in improving the

subjects’ health, which in turn improved the socio-economic parameters.

Macronutrient supplements (calories, protein, carbohydrate, fat and fibre) were

provided to 10,780 people and micronutrient supplements (Vitamin A, B, C and

folic acid, to name a few) in the form of tablets to 11,109.

The results are quite startling.

CD4 count

The most significant improvement was seen in the CD4 count in those on

treatment. A person infected with HIV is provided ART only when his/her CD4

count comes below 200.

In the case of those on ART, the CD4 count that was 113 at the time of starting

the study, shot up to 309 six months after the supplementation programme, and

finally reached 402 at the end of the 18-month study period. In the case of

those who do not require ART, the improvement was marginal — 494 at the start

to 515 at the end of the study duration.

It must be remembered that CD4 count indicates how good the immune system of a

person is. It is particularly important in the case of HIV/AIDS as the virus

destroys the very immune system that is supposed to fight it. So a higher CD4

count reflects a strong immune system and hence its ability to fight the virus.

Delay progression

The study has thus confirmed what is well known. Good nutrition plays a vital

role in keeping the CD4 count higher. “This will help in delaying the

progression of the disease,†said Ms. Supriya Sahu, Project Director, TANSACS.

This means that it will take a longer time for a person to reach a stage where

he would require medication. And for those already on ART, an improvement in CD4

count delays the onset of AIDS related health problems.

Apart from improving the CD4 count, good nutrition also helped people gain

weight. Weight gain was 5 kg in the case of men and 4 kg in the case of women on

ART; it was 4 kg in men and 2 kg in the case women who were not did not need

treatment.

“We did not see a direct relationship between micronutrients and weight

gain,†said Ms. Sahu.

“The 6- and 12-month results were so very encouraging that we introduced the

supplementation programme in all the 26 ART centres in the State,†she said.

The programme introduced in March-April 2007 covers 21,000 people who are on

ART.

Tamil Nadu has initiated the supplementation programme although it is not a part

of the national agenda.

TB co-infection

Good health is not just about keeping the CD4 count higher. A healthy person

with a robust immune system is less likely to become actively infected with TB.

Though many Indians are infected with TB bacteria at any given point of time, a

person becomes diseased only when the immune system is weak or compromised. That

is precisely the reason why co-infection with TB is seen more commonly in people

with HIV/AIDS.

The study found that as the health of people improved, the rate of TB dropped.

Again the most significant drop was seen in those on ART — from 25 per cent

co-infected with TB at the start of the study to 5 per cent at the end of the

study period. This is only to be expected as those on ART had a weaker immune

system. In the case of those who did not need treatment, TB rate dropped from 10

to 3 per cent after 18 months.

Other than TB, the major opportunistic infections affecting people with AIDS

showed a drastic drop from 46 per cent to 10 per cent at the end of the study

period. The drop was 20 to 10 per cent in the case of those who did not require

ART.

Percentage employed

Employment is one of the biggest casualties as health deteriorates. It has been

well documented that the ability to remain employed drops significantly as the

disease progresses and the person’s health deteriorates.

But with the nutritional supplementation improving health, the percentage of

people being employed showed a very significant jump. It had the greatest impact

on those who were on ART — the percentage more than doubled from 30 at the

start of the study to 62 after 18 months.

In the case of those who not on ART, the percentage increase was 48 to 64 at the

end of 18 months.

Analysis of the data showed that improved health was not just about being

employed. The number of hours worked in a week shot up from 11 to 31 at the end

of one year and then dropped to 27 at the end of 18 months in those on ART. The

second group showed a steady increase from 19 hours to 27 hours for the same

period.

The increase in the number of hours worked thus resulted in more income

generation in both groups — those on ART and those who were not.

In the case of children, the school going status and attendance improved

significantly.

In the end, nutritional supplementation is not all about health benefits. It

also leads to better psychosocial and socioeconomic outcomes.

“The take home message is simple,†Ms. Sahu said, “one needs to take care

of one’s health the moment one gets infected with HIV. Else the CD4 count

starts to drop, body weight starts to reduce and there will be increase in

opportunistic infections.â€

And the cost is just Rs.900 per person per year. “It is very reasonable,â€

she noted. Of course it is, if one considers the savings that would result from

the government not spending money on medicines for TB and other opportunistic

infections that would afflict persons with AIDS.

http://www.hindu.com/seta/2008/07/31/stories/2008073150121400.htm