Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions.

Autor: Fuseini H; Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana. hubaida.fuseini.1@vumc.org.; Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana. hubaida.fuseini.1@vumc.org.; Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, 37232-2582, USA. hubaida.fuseini.1@vumc.org., Gyan BA; Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana.; Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana., Kyei GB; Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana.; Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana.; Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA., Heimburger DC; Vanderbilt Institute for Global Health, Nashville, TN, USA., Koethe JR; Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, 37232-2582, USA.; Vanderbilt Institute for Global Health, Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Current HIV/AIDS reports [Curr HIV/AIDS Rep] 2021 Apr; Vol. 18 (2), pp. 87-97. Date of Electronic Publication: 2021 Feb 19.
DOI: 10.1007/s11904-021-00541-6
Abstrakt: Purpose of Review: Sub-Saharan Africa (SSA) is disproportionately burdened by the twin epidemics of food insecurity and HIV infection, and protein-calorie undernutrition is common among persons with HIV (PWH) initiating antiretroviral therapy (ART) in the region. In this review, we discuss the intersection of HIV infection and undernutrition, health outcomes among undernourished PWH starting ART, and the demonstrated and potential benefits of therapeutic interventions such as micro/macronutrient supplementation and pharmacological agents.
Recent Findings: A low body mass index (BMI), used as a general indicator of poor nutrition in most studies, is associated with impaired immune recovery and increased mortality in the early ART period. The increased risk of mortality is multifactorial, and contributors include undernutrition-related immune system dysfunction, increased susceptibility to opportunistic infections, and metabolic and cardiovascular dysregulation. Clinical trials of micro/macronutrient supplementary feeding, appetite stimulants (hormones and anabolic agents), and recombinant adipokines have shown a benefit for weight gain and metabolic health, but there are few data on mortality or immune recovery. A substantial proportion of PWH in SSA are undernourished, and undernutrition contributes to an increased risk of mortality and other adverse health outcomes. To date, there have been few prospective trials of nutritional supplementation and/or pharmacologic therapy among undernourished PWH in SSA, though findings from other settings suggest a potential benefit in this population.
Databáze: MEDLINE
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