Session 7 Malnutrition and anemiax
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Transcript Session 7 Malnutrition and anemiax
MALNUTRITION
MALNUTRITION AMONG IDUS:
BASIC FACTS
Drug
users are at increased risk of malnutrition
regardless of whether or not they are infected with
HIV
Specific
drugs may alter appetite, interfere with
gastrointestinal absorption, and/or have
proinflammatory responses that can lead to
disturbances in metabolic rate
Behaviorally,
drug dependence may affect access
to food and food selection
MALNUTRITION AMONG IDUS:
BASIC FACTS
The HIV infected drug users at greater risk for malnutrition
The risk of comorbid conditions, such as hepatitis C (HCV)
and tuberculosis (TB), is increased among drug using
populations and may further affect nutritional and
metabolic status
MALNUTRITION AMONG IDUS:
BASIC FACTS
Malnutrition
may impact the course of HIVinfection through a variety of mechanisms:
compromising host immune function
diminishing response to therapies
promoting co-morbidities
NUTRITION AMONG IDUS
Nutritional
compromise has been a hallmark of
untreated HIV infection
Persons
with HIV infection often have inadequate
dietary intake of calories, protein, and
micronutrients
They
have unintentional weight loss which is a
strong predictor of mortality
NUTRITIONAL STATUS OF IDUS: INDIA
Poor nutritional status in both HIV-positive and HIV-negative
drug users
Nutritional status worse in HIV positive drug users
52% of HIV-positive drug users and 50% of HIV-negative drug
users having BMI levels below 18.5 kg/m2
HIV-positive IDUs had significantly lower levels of fat mass, fatfree mass, and percent body fat than the HIV-negative IDUs
HIV-positive IDUs had lower cholesterol levels and higher
triglycerides than HIV-negative IDUs
Tang et al, 2011
NUTRITIONAL STATUS OF IDUS: INDIA
Conditions which most certainly place HIV positive IDUs at
higher risk of continued malnutrition:
self-reported TB
diarrhea
laboratory-confirmed Hepatitis C infection among the
HIV-positive IDUs
Tang et al, 2011
SIGNIFICANCE OF IMPROVING NUTRITION
AMONG HIV POSITIVE IDUS
Emerging evidence suggests that poor nutritional status at
the start of ARV treatment is predictive of mortality
It may be important to improve nutritional status in the
HIV-positive population prior to initiation of ARV treatment
in order for patients to reap the full benefits of therapy
ANAEMIA
ANAEMIA IN DRUG USERS
Anaemia is highly prevalent among injecting drug
users, both HIV infected and HIV uninfected
Anaemia may be contributed significantly by nutritional
disorders among IDUs
Anaemia is highly correlated with frequency of
injection and it is suggested that cessation of injection
use may improve anaemia
Anaemia contributes to increased morbidity as well as
mortality
ANAEMIA IN HIV INFECTED DRUG USERS
Anemia is a common clinical finding in HIV-infected
patients and is associated with:
advanced disease
lower quality of life
higher mortality
Factors contributing to the development of anemia
nutritional deficiencies
opportunistic infections
AIDS-related malignancies
drug treatment
direct effect of HIV on the bone marrow
ANAEMIA IN HIV INFECTED DRUG USERS
Zidovudine,
an ARV can contribute to
anaemia
Iron
deficiency
Inflammation-induced
HCV
iron
iron maldistribution of iron
may possibly contribute to redistribution of
ART AND ANAEMIA
ART can improve anaemia in HIV infected drug users:
Reduction of opportunistic infections
Reduction of associated anemia of chronic disease
Reduction of gut abnormalities
Improvement in micronutrient status