SHIFTING PARADIGM OF NUTRITION CHALLENGES IN HIV

Since the introduction of anti-retroviral therapy (ART), HIV wasting syndrome has become a thing of the past as people enjoy better health (HATiP, Issue 182, 06 October 2011). However as the condition has become more of a chronic disease with people living longer and ageing, the common trend now is overweight and obesity. Individuals living with the virus are now exposed to risk factors of non-communicable diseases similar to those of the general population, in addition to the risk factors associated with the infection and the ART. The result is nutrition challenges such as diabetes, hypertension; dyslipidemia among others (UNAIDS).

Now the risk of non-communicable diseases comorbidity in people living with HIV is expected to increase in the developing countries. This would affect the prognosis and quality of life of the individuals, not to mention the cost of care.  This is to mean that one line HIV programmes would only succeed in preventing death from HIV but not death of patients.

HIV and NCDs care however have common similarities since both require health systems that can provide for long term chronic care needs. Both also have common elements of prevention and management which include community and family support, patient involvement, and continuous follow up. This provides an opportunity to ride on the successes of HIV programming whose structures and models can be adopted for integration of NCDs in HIV care and management. And if the pilot reports (such as in an integrated chronic disease clinic in Cambodia) are anything to go by, there is better retention and health outcomes, including reduced stigma among PLWHIV where NCD services have been integrated in HIV care and management.

From my observation over the years we have focused so much on under-nutrition that over-nutrition and the related complications seem to have caught us unaware. Now that we got a wakeup call, we need to rethink our interventions beyond wasting in HIV, and particularly provide data on the same.

But even as we rethink, we need to ask the hard questions. Like, what about the urban poor living with HIV, but are obese? Are you wondering how that is possible? Well visit one of these neighborhoods. Food is there, cheap even, only it is a lot of carbohydrates, refined and energy dense food which you cannot advise against since all this person needs is something to fill their stomach.

All the same kudos to the Ministry of Health’ Division of Non-Communicable Diseases on the launch of the NCD strategy: kazi sasa.