HIV/AIDS, TB and Nutrition: Scientific inquiry into the nutritional influences on human immunity with special reference to HIV infection and active TB in South Africa
Consensus Study report
The availability of highly effective drugs to control HIV/AIDS and cure tuberculosis has tended to downplay the potential benefits that may accompany appropriate supportive measures, designed to complement or precede pharmacotherapy, to arrest progression from infection to disease (TB), or to delay the rate of progression of the earlier phases of the illness, before specific medicinal interventions are indicated (HIV). Nutritional support is one such potentially valuable measure. Clearly the clinical efficacy of nutritional intervention is likely to be dependent on the extent to which individual infected subjects suffer from functionally significant nutritional deficiencies prior to nutritional intervention. The same argument is generally pertinent to interventions at population level – populations of infected subjects with a high prevalence of nutritional deficiency, such as those in developing countries, are more likely to benefit from health policies aimed at eradicating or diminishing nutritional deficiencies than are populations in developed countries, from where much of the reported research has emanated. It is important to bear in mind that the pre-antibiotic phase of dealing with TB was characterized by intense concentration on strengthening the immune defenses of infected subjects with diets, improved and altered environmental conditions and every other conceivably helpful measure. After the discovery of effective drugs, this aspect of TB therapy quickly became secondary and largely uncontroversial. Because HIV infection cannot be cured but only controlled, with drugs being applied at particular, serious stages of progressive disease (according to current guidelines, at least) the emphasis in the management of infected people during the phases prior to drug administration is still on general, non-pharmacological support, especially as for many reasons it is highly desirable to postpone the introduction of specific antiretroviral therapy for as long as possible. This background has motivated the current study, which has analyzed the relevant scientific literature, concentrating on regionally relevant studies, with a view to providing the best possible, evidence-based advice for South African policymakers. The over-arching conclusion from this analysis is that there is a lamentable paucity of relevant, solid data on which to base sound policies for this country. Recognizing the dire need to deal optimally, right now, with an existing health crisis, this study has evaluated the current nutritional guidelines from the World Health Organization, the national Department of Health, and the Southern African HIV/AIDS Clinicians Society, in the light of what scientific evidence is available. Broadly, these guidelines are endorsed in the current analysis as being generally close to the best possible in the prevailing circumstances. The study, having identified serious gaps in our knowledge, has compiled a set of critical research questions, guided by evolving understanding of the relevant basic science. The panel urges that the answering of these questions should be given high priority by research policy makers in the hope that the insights thereby gained will provide the kind of solid evidence on which refined policies for the practice of healthcare can safely and effectively be based in future.