Infectious Diseases
Nutrition and immune function in human immunodeficiency virus infection.
Macallan DC
Proc Nutr Soc 1999 Aug;58(3):743-8 The triad of human immunodeficiency
virus (HIV) infection, nutritional status and immune function are intimately
related, each factor having effects on the others. The dominant effect
in this three-way relationship is the effect of HIV infection on nutritional
status, an effect which, until the advent of potent anti-retroviral drugs,
has been manifest primarily as wasting. Recently, more complex metabolic
abnormalities have become apparent, particularly fat redistribution syndromes,
hyperlipidaemia and hypercholesterolaemia. For the converse effect, the
effect of nutritional state on HIV disease progression, there is good
evidence that clinical outcome is poorer in individuals with compromised
nutrition. However, the beneficial effects of nutritional support have
been more difficult to demonstrate. For macronutrients, effective macronutrient
supply improves survival in severely-malnourished individuals and may
have beneficial effects in less-severely-affected individuals. Micronutrient
deficiencies appear to be involved in modifying clinical HIV disease and
may also be associated with enhanced mother-to-child transmission of virus,
particularly in developing countries. Intervention trials in this setting
are currently under way. In conclusion, the interaction of HIV infection
and nutrition is of great importance not just because of the major impact
that HIV infection has on nutritional state, but also because strategies
to improve nutritional status, both quantitatively and qualitatively,
may have a beneficial effect on the clinical and immunological course
of the disease. |