de Pee Saskia, Semba Richard D
World Food Programme, Rome.
Food Nutr Bull. 2010 Dec;31(4):S313-44.
HIV infection and malnutrition negatively reinforce each other.
For program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resource-limited settings.
Adequate nutritional status supports immunity and physical performance. Weight loss, caused by low dietary intake (loss of appetite, mouth ulcers, food insecurity), malabsorption, and altered metabolism, is common in HIV infection. Regaining weight, particularly muscle mass, requires antiretroviral therapy (ART), treatment of opportunistic infections, consumption of a balanced diet, physical activity, mitigation of side effects, and perhaps appetite stimulants and growth hormone. Correcting nutritional status becomes more difficult as infection progresses. Studies document widespread micronutrient deficiencies among HIV-infected people. However, supplement composition, patient characteristics, and treatments vary widely across intervention studies. Therefore, the World Health Organization (WHO) recommends ensuring intake of 1 Recommended Nutrient Intake (RNI) of each required micronutrient, which may require taking micronutrient supplements. Few studies have assessed the impact of food supplements. Because the mortality risk in patients receiving ART increases with lower body mass index (BMI), improving the BMI seems important. Whether this requires provision of food supplements depends on the patient's diet and food security. It appears that starting ART improves BMI and that ready-to-use fortified spreads and fortified-blended foods further increase BMI (the effect is somewhat less with fortified-blended foods). The studies are too small to assess effects on mortality. Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity). Food insecurity should also be addressed if it prevents adequate energy intake and reduces treatment initiation and adherence (due to the opportunity costs of obtaining treatment and mitigating side effects).
HIV感染与营养不良相互影响，形成恶性循环。
为项目指导提供参考，综述资源有限环境下成人HIV感染与营养不良关系的证据。
充足的营养状况有助于维持免疫力和身体机能。HIV感染患者常因饮食摄入不足（食欲不振、口腔溃疡、食物不安全）、吸收不良及代谢改变而体重减轻。恢复体重，尤其是增加肌肉量，需要抗逆转录病毒疗法（ART）、治疗机会性感染、均衡饮食、体育锻炼、减轻副作用，可能还需要使用食欲刺激剂和生长激素。随着感染进展，纠正营养状况变得更加困难。研究表明，HIV感染者普遍存在微量营养素缺乏的情况。然而，不同干预研究中的补充剂成分、患者特征和治疗方法差异很大。因此，世界卫生组织（WHO）建议确保摄入每种所需微量营养素的1个推荐营养素摄入量（RNI），这可能需要服用微量营养素补充剂。很少有研究评估食品补充剂的影响。由于接受ART治疗的患者死亡率风险随体重指数（BMI）降低而增加，提高BMI似乎很重要。是否需要提供食品补充剂取决于患者的饮食和食品安全状况。开始ART治疗似乎可提高BMI，即食强化涂抹酱和强化混合食品可进一步提高BMI（强化混合食品的效果稍弱）。这些研究规模太小，无法评估对死亡率的影响。一旦开始ART治疗并治疗了营养不良，饮食的营养质量仍然很重要，这也是由于ART的长期代谢影响（血脂异常、胰岛素抵抗、肥胖）。如果食物不安全妨碍了足够的能量摄入，并降低了治疗的启动率和依从性（由于获得治疗和减轻副作用的机会成本），也应予以解决。
