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July 2008:
- AIDS- Importance of nutrition confirmed
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> September 2008 clipings
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An 18-month study on more than 10,500 people with HIV/AIDS in Tamil
Nadu found nutritional supplements improved their health - The Hindu
30 July 2008 |
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In what may be the biggest study ever conducted in India, the Tamil
Nadu State AIDS Control Society (TANSACS) has found conclusive
evidence that providing micro and macronutrients to people living
with HIV/AIDS greatly improves their health and quality of life.
The 18-month study undertaken in association with Duke University
was started in September 2005 in the State. It was undertaken in
three centers, covering 10 districts that provide anti-retroviral
therapy (ART).
It involved the supply of both micro and macronutrients to people,
both adults and children, who were on ART as well as those who did
not require it. The objective was to study how nutritional
supplementation helped in improving the subjects’ health, which in
turn improved the socio-economic parameters.
Macronutrient supplements (calories, protein, carbohydrate, fat and
fibre) were provided to 10,780 people and micronutrient supplements
(Vitamin A, B, C and folic acid, to name a few) in the form of
tablets to 11,109.
The results are quite startling.
CD4 count
The most significant improvement was seen in the CD4 count in those
on treatment. A person infected with HIV is provided ART only when
his/her CD4 count comes below 200.
In the case of those on ART, the CD4 count that was 113 at the time
of starting the study, shot up to 309 six months after the
supplementation program, and finally reached 402 at the end of the
18-month study period. In the case of those who do not require ART,
the improvement was marginal — 494 at the start to 515 at the end of
the study duration.
It must be remembered that CD4 count indicates how good the immune
system of a person is. It is particularly important in the case of
HIV/AIDS as the virus destroys the very immune system that is
supposed to fight it. So a higher CD4 count reflects a strong immune
system and hence its ability to fight the virus.
Delay progression
The study has thus confirmed what is well known. Good nutrition
plays a vital role in keeping the CD4 count higher. “This will help
in delaying the progression of the disease,” said Ms. Supriya Sahu,
Project Director, TANSACS.
This means that it will take a longer time for a person to reach a
stage where he would require medication. And for those already on
ART, an improvement in CD4 count delays the onset of AIDS related
health problems.
Apart from improving the CD4 count, good nutrition also helped
people gain weight. Weight gain was 5 kg in the case of men and 4 kg
in the case of women on ART; it was 4 kg in men and 2 kg in the case
women who were not did not need treatment.
“We did not see a direct relationship between micronutrients and
weight gain,” said Ms. Sahu.
“The 6- and 12-month results were so very encouraging that we
introduced the supplementation program in all the 26 ART centers in
the State,” she said. The program introduced in March-April 2007
covers 21,000 people who are on ART.
Tamil Nadu has initiated the supplementation program although it is
not a part of the national agenda.
TB co-infection
Good health is not just about keeping the CD4 count higher. A
healthy person with a robust immune system is less likely to become
actively infected with TB. Though many Indians are infected with TB
bacteria at any given point of time, a person becomes diseased only
when the immune system is weak or compromised. That is precisely the
reason why co-infection with TB is seen more commonly in people with
HIV/AIDS.
The study found that as the health of people improved, the rate of
TB dropped. Again the most significant drop was seen in those on ART
— from 25 per cent co-infected with TB at the start of the study to
5 per cent at the end of the study period. This is only to be
expected as those on ART had a weaker immune system. In the case of
those who did not need treatment, TB rate dropped from 10 to 3 per
cent after 18 months.
Other than TB, the major opportunistic infections affecting people
with AIDS showed a drastic drop from 46 per cent to 10 per cent at
the end of the study period. The drop was 20 to 10 per cent in the
case of those who did not require ART.
Percentage employed
Employment is one of the biggest casualties as health deteriorates.
It has been well documented that the ability to remain employed
drops significantly as the disease progresses and the person’s
health deteriorates.
But with the nutritional supplementation improving health, the
percentage of people being employed showed a very significant jump.
It had the greatest impact on those who were on ART — the percentage
more than doubled from 30 at the start of the study to 62 after 18
months.
In the case of those who not on ART, the percentage increases was 48
to 64 at the end of 18 months.
Analysis of the data showed that improved health was not just about
being employed. The number of hours worked in a week shot up from 11
to 31 at the end of one year and then dropped to 27 at the end of 18
months in those on ART. The second group showed a steady increase
from 19 hours to 27 hours for the same period.
The increase in the number of hours worked thus resulted in more
income generation in both groups — those on ART and those who were
not.
In the case of children, the school going status and attendance
improved significantly.
In the end, nutritional supplementation is not all about health
benefits. It also leads to better psychosocial and socioeconomic
outcomes.
“The take home message is simple,” Ms. Sahu said, “one needs to take
care of one’s health the moment one gets infected with HIV. Else the
CD4 count starts to drop, body weight starts to reduce and there
will be increase in opportunistic infections.”
And the cost is just Rs.900 per person per year. “It is very
reasonable,” she noted. Of course it is, if one considers the
savings that would result from the government not spending money on
medicines for TB and other opportunistic infections that would
afflict persons with AIDS. |
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