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Nutritional Aspects of Drug Abuse and HIV


Sherwood L. Gorbach, M.D.
Tufts University of Medicine


Learning Objectives

  • Understand the nutritional deficiencies seen in protein-caloric malnutrition and their relation to HIV infection.

  • Learn the role of decreased dietary intake and micronutrient deficiency in progression of HIV.

Abstract

Drug abuse has become the leading risk factor for acquisition of HIV in the USA. The minority communities are especially impacted by the twin treats of drugs and the virus. There is accumulating evidence that nutritional status influences the progression of HIV and also has implications for response to HAART and side effects of treatment. AIDS patients can develop severe weight loss, known as wasting, which is seen even in patients who are receiving HAART. A persistent question in AIDS wasting is the extent to which protein-calorie malnutrition (PCM) plays a role in the immunological and clinical findings, particularly in drug abusers who may have borderline dietary intake. It is known that PCM can produce multiple immunologic defects, most of which are also seen in HIV infection. All of these abnormalities are reversed in PCM by nutritional rehabilitation, the major differentiating point between PCM and HIV. Yet, a recent study among HIV patients in Africa by Fawzi et al. showed that micronutrient supplementation can increase the numbers of CD4 cells. The role of PCM and micronutrient deficiencies in drug abusers with HIV is poorly defined because of a paucity of good nutrition and metabolic studies. More information is needed among drug abusers with HIV, with an emphasis on the minority communities and women, in order to develop appropriate nutritional interventions.

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