MALNUTRITION MALNUTRITION AMONG IDUS BASIC FACTS Drug users

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 HIV-infection through a variety of mechanisms: compromising diminishing promoting host immune function response to therapies 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 HIVnegative drug users Nutritional status worse in HIV positive drug users 52% of HIV-positive drug users and 50% of HIVnegative drug users having BMI levels below 18. 5 kg/m 2 HIV-positive IDUs had significantly lower levels of fat mass, fat-free mass, and percent body fat than the HIV-negative IDUs Tang et and al, 2011 HIV-positive IDUs had lower cholesterol levels higher triglycerides than HIV-negative IDUs

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 HIVinfected 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 iron maldistribution of iron HCV may possibly contribute to redistribution of iron

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