Hidden hunger &_hiv


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Hidden Hunger and HIV affects children in sub-Saharan Africa

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Hidden hunger &_hiv

  1. 1. Health Empowerment Through Nutrition Hidden Hunger & HIV
  2. 2. HIV/AIDS – The Problem <ul><li>This pandemic has resulted in 60 million people infected by the end of 2005 </li></ul><ul><li>More than 25 million have died </li></ul><ul><li>People living with HIV/AIDS in 2007 numbered over 33 million </li></ul><ul><li>Young people account for half of all new infections - around 6,000 per day </li></ul><ul><li>Africa is facing a desperate plight and has 12 million AIDS orphans </li></ul>
  3. 3. HIV/AIDS - The Facts <ul><li>More than 50 peer reviewed journal articles show that </li></ul><ul><ul><li>Micronutrients, including the vitamins A, B6, B12 and E, and the minerals selenium and zinc, play a critical role in the maintenance of immune function and overall metabolism </li></ul></ul><ul><ul><li>The HIV virus encodes the seleno-enzyme glutathione peroxidase, thereby robbing the host of selenium and the amino acids, cysteine, glutamine, and tryptophan </li></ul></ul><ul><ul><li>Persons living with AIDS suffer from extreme deficiencies of all of these nutrients, which can also be responsible for depressed CD4 counts, vulnerability to infections and cancers, dementia, depression, diarrhoea, muscle wasting, neuropathy and skin diseases </li></ul></ul>
  4. 4. Selenium <ul><li>HETN does not support single issue environmentalism nor single fixes, but by way of illustration </li></ul><ul><ul><li>In Kupka’s study of 949 HIV infected, pregnant Tanzanian women, lower plasma selenium levels were significantly associated with an increased mortality. Each 0.1µmol/l increase in plasma selenium levels were related to a 5% decreased mortality over 5.7 years of follow up </li></ul></ul><ul><ul><li>It has been demonstrated that, in patients living with HIV/AIDS, plasma selenium levels are a better indicator of morbidity and longevity than CD4 counts </li></ul></ul>
  5. 5. Selenium, Cont. <ul><li>Odunukwe’s recent study examined the impact of selenium supplementation in Nigerians with advanced disease (CD4 cell counts < 50) who are on ART </li></ul><ul><ul><li>170 participants received 200 µ g of selenium daily and 170 received antiretroviral therapy alone. Patients were followed for 72 weeks </li></ul></ul><ul><ul><li>The rate of CD4 cell recovery was significantly higher and the median CD4 count increment was over twofold higher in patients on selenium supplementation (+120 cells/mm3 v. +50 cells/mm3) </li></ul></ul><ul><ul><li>The incidence of opportunistic infections was lower resulting in fewer hospital visits </li></ul></ul><ul><ul><li>Weight gain was significantly higher (p = 0.004). </li></ul></ul><ul><ul><li>Haemoglobin increment from baseline to 64 weeks was 3-fold higher (+30 g/l v. +10g/l) </li></ul></ul>
  6. 6. Selenium, Cont. <ul><li>Onother recent study by Hurwitz followed 174 HIV+ patients over 9 months. 91 of them received 200 µ g/day of selenium yeast </li></ul><ul><ul><li>Serum selenium concentration increased significantly in the selenium-treated group but not in the placebo-treated group (+32.2μg/l v. +0.5μg/l) ( P <0.001) </li></ul></ul><ul><ul><li>Greater levels of selenium (in the ‘responders’) were significantly associated with decreased HIV viral load ( P <0.02) compared with controls </li></ul></ul><ul><ul><li>This correlated with a significantly increased CD4 count ( P <0.04) </li></ul></ul><ul><ul><li>Selenium ‘non-responders’ did not differ from the placebo group in HIV levels and CD4 counts </li></ul></ul>
  7. 7. Parallel Evidence <ul><li>The HIV/AIDS pandemic is only one of several, involving viruses that encode the seleno-enzyme glutathione peroxidase </li></ul><ul><li>Hepatitis B and C viruses, the Coxsackie B virus and HIV do likewise </li></ul><ul><li>The Chinese are winning a battle against the Coxsackie B virus which causes Keshan disease, a fatal heart ailment that has been common for many years in inhabitants of the great selenium-deficiency belt that crosses China </li></ul>
  8. 8. Parallel Evidence, Cont. <ul><li>Finland has shown that selenium supplementation can have a major beneficial impact on the incidence of HIV/AIDS </li></ul><ul><li>Despite widespread, unprotected, promiscuous sexual activity in Senegal, where soil selenium levels are naturally high, HIV is diffusing very slowly, if at all, amongst the population </li></ul><ul><li>In the UK there is an epidemic of TB among badgers, which is infecting cattle. It has been shown that organic herds fed on clover, which is rich in selenium, are not susceptible. When badgers and traditional herds are given maize supplemented with selenium, they are no longer susceptible </li></ul>
  9. 9. HIV/AIDS - Current Strategies - Education <ul><li>Dedicated largely to creating awareness and promoting behaviour change. </li></ul><ul><li>The ABC approach - Abstinence, Be Faithful, Use Condoms - is based on a western, Judaio-Christian view of the world. It assumes that recipients of the imparted knowledge believe in cause and effect, self-actualisation and individual responsibility. The African tradition is often at odds with this. </li></ul><ul><li>Where children are your social security, condoms offer no hope. </li></ul><ul><li>Many people, particularly women, do not feel empowered. </li></ul>
  10. 10. HIV/AIDS - Current Strategies - Education <ul><li>It is interesting that, in the UK, HIV is diffusing very slowly, despite the highest teenage pregnancy rate in Europe and a serious epidemic of chlamydia among young people. </li></ul><ul><li>The major problem in Africa is not greater promiscuity, but the high incidence of multiple, concurrent sexual partners. </li></ul>
  11. 11. HIV/AIDS - Current Strategies – Medication <ul><li>Anti-retroviral therapy (ART). This has been a lifesaver, and has great appeal to Western minds, still wedded to pharmaceutical solutions, but </li></ul><ul><ul><li>It is not curative </li></ul></ul><ul><ul><li>Huge cost - all donor-dependent, so sustainability is questionable </li></ul></ul><ul><ul><li>No access for the vast majority of people living with HIV/AIDS in Africa, and this will not change </li></ul></ul><ul><ul><li>Frequent shortages, which encourage drug resistance </li></ul></ul><ul><ul><li>Compliance is a major problem </li></ul></ul><ul><ul><li>Numerous side effects, which are more frequent in people who are malnourished </li></ul></ul><ul><ul><li>Many do not cross the blood-brain barrier, so brain damage can continue </li></ul></ul>
  12. 12. We Are Not Winning <ul><li>20 years ago the prevalence of HIV infection in Swaziland was less than one in a thousand. By 2004, despite huge education programmes, it had reached 48% among antenatal clinic attendees. Today, over one third of the adult population is infected - the world's highest prevalence rate </li></ul><ul><li>The management of HIV and AIDS is an ongoing challenge for Southern African companies. HIV prevalence among employees of Anglo American companies is estimated to be 23%. At AngloGold Ashanti it is 30%. </li></ul><ul><li>The soils of Southern Africa are seriously depleted. Selenium levels are very low. The staple food, maize, contains very little. </li></ul><ul><li>We need a new paradigm . </li></ul>
  13. 13. The Scale of the Problem <ul><li>In Sub-Saharan Africa there will be 20 million orphans by 2010, the year of the Football World Cup. Everybody is preparing for the latter. Nobody is preparing for the orphan pandemic. </li></ul><ul><li>In South Africa 5.5 million people are infected. There are 500,000 new infections every year. By 2010 over 10 million people could be infected. </li></ul><ul><li>The SA Department of Health have launched the largest ART rollout program in the world at a cost of R12 billion. This will treat 1.2 million people by 2010. </li></ul><ul><li>By then there will be 8–9 million people in the queue that nobody is planning to support. These people will flood the clinics and swamp the infrastructure. </li></ul><ul><li>South Africa, a relatively prosperous country, faces this 2 years from now. What hope for the rest of Africa? </li></ul>
  14. 14. Meanwhile <ul><li>Multi-resistant TB is spreading unabated </li></ul><ul><li>Africa's nutritional crisis is not seen, heard or understood </li></ul><ul><li>Africans have moved away from their traditional foods without any understanding of the role the present food chain plays in compounding the health issues facing the continent </li></ul><ul><li>Imported food aid, commercially grown and processed, is dumped with little understanding of the nutritional implications </li></ul>
  15. 15. Hidden Hunger & HIV <ul><li>HETN does not support single issue environmentalism nor single fixes. </li></ul><ul><li>We support the work being done to encourage behaviour change and to make ART more available. </li></ul><ul><li>We deplore the fact that the crucial role of micronutrition in HIV/AIDS has not yet gained mainstream acceptance. </li></ul><ul><li>It is our belief that the management of people living with HIV/AIDS should include supplementation with micronutrients, at least to levels at which deficiency symptoms associated with a lack of these nutrients disappear. </li></ul>
  16. 16. Hidden Hunger & HIV <ul><li>Good health is enabled and maintained by good nutrition </li></ul><ul><ul><li>Hidden hunger affects more than two billion people. Even when a person consumes adequate calories and protein, if they lack one single micronutrient - or a combination of vitamins and minerals – their immune system is compromised, and infections take hold </li></ul></ul><ul><li>World Hunger Series 2007 - Hunger and Health </li></ul><ul><li>World Food Programme </li></ul>
  17. 17. Hidden Hunger & HIV <ul><li>With the knowledge that </li></ul><ul><ul><li>Chronic malnutrition is the biggest cause of immune suppression in humans </li></ul></ul><ul><ul><li>Primary micronutrient deficiencies are widespread and severe in Africa </li></ul></ul><ul><ul><li>People living with HIV/AIDS suffer from extreme deficiencies of many micronutrients </li></ul></ul><ul><ul><li>>>>>> </li></ul></ul>
  18. 18. Hidden Hunger & HIV <ul><li>And evidence that </li></ul><ul><ul><li>There is a clear relationship between HIV infection and nutritional status </li></ul></ul><ul><ul><li>Malnourished individuals are more susceptible to HIV infection and have a worse prognosis </li></ul></ul><ul><ul><li>Food nutrients, particularly the antioxidant micronutrients, have therapeutic benefit </li></ul></ul><ul><ul><li>>>>>> </li></ul></ul>
  19. 19. Hidden Hunger & HIV <ul><li>One might assume that the management of people living with HIV/AIDS would include supplementation with micronutrients, but this is not the case </li></ul><ul><ul><li>Micronutrient supplementation has not become part of mainstream thinking in the fight against HIV/AIDS </li></ul></ul><ul><ul><li>Global interventions consist of education to promote behaviour change and the roll out of anti-retroviral therapy (ART) </li></ul></ul><ul><ul><li>In Southern Africa, the issue has been marginalised by a damaging public media debate on nutrition versus drugs that has polarised proponents of nutrition on the one hand and proponents of ART on the other </li></ul></ul><ul><ul><li>This either/or debate is specious and does not serve anyone </li></ul></ul>
  20. 20. Hidden Hunger & HIV <ul><li>Systematic reviews of micronutrient supplementation conclude that there is no convincing evidence that micronutrient supplementation effectively reduces morbidity and mortality in people living with HIV/AIDS </li></ul><ul><ul><li>But the trials that have been done concentrate on single supplement intervention, or supplementation with a small group of micronutrients. Neither can be expected to correct the type of nutrient deficiency seen in HIV/AIDS </li></ul></ul><ul><ul><li>The problem is compounded by the fact that the dose of supplement is often not physiological and the form of supplement is often not considered </li></ul></ul><ul><ul><li>Much of the research is done in the West where baseline nutrition is higher </li></ul></ul>
  21. 21. Hidden Hunger & HIV <ul><li>Nevertheless, the WHO is urging all concerned parties to make nutrition an integral part of their response to HIV/AIDS, and specifically to develop and implement operational and clinical research to identify effective interventions and strategies for improving the nutrition of HIV-infected persons. </li></ul><ul><li>It is feasible to provide the necessary supplements in a ‘food’ form, which significantly improves bioavailability and therefore effectiveness in supporting immune function. </li></ul>
  22. 22. Hidden Hunger & HIV <ul><li>In conjunction with London University and the University of the Witwatersrand, HETN is conducting a controlled trial in a rural clinical setting </li></ul><ul><ul><li>150km of urban shanty sprawl. Few jobs, little water, serious poverty, 1 million people </li></ul></ul><ul><ul><li>The soils are so depleted, the people struggle to grow anything. </li></ul></ul>
  23. 23. <ul><li>This programme, involving 3 hospitals and 45 clinics in the Limpopo Province, is doing an impressive job, but their research to date has not include micronutrition. </li></ul><ul><li>The aim of this trial is to show that the addition of a broad-spectrum micronutrient supplement, in a food form, to the ART regime of people living with HIV/AIDS improves clinical outcomes. </li></ul>
  24. 24. Hidden Hunger <ul><li>It seems strange to some that medical scientists require controlled trials to prove that correcting micronutrient deficiencies is good for you. </li></ul><ul><li>The ‘man in the street’ knows it intuitively. </li></ul><ul><li>>>>>> </li></ul>
  25. 25. Before & After
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  27. 27. Before & After
  28. 28. Before & After
  29. 29. In Conclusion <ul><li>HETN is not selling anything other than a desire to discover the truth. </li></ul><ul><li>We believe that in the HIV/AIDS arena there is sufficient anecdotal and research data to construct a plausible micronutrient hypothesis that is worthy of scrutiny. </li></ul><ul><li>Where the plight is serious and the hypothesis is strong, science has a duty to research. </li></ul><ul><li>Given the parlous nature of the HIV pandemic, there is a moral imperative to be inclusive in our thinking. </li></ul><ul><li>The time is now. </li></ul>