NUTRITION IN HIV/AIDS

Satish John Vishaal: H31/34751/2013

Gacheru Jane Njoki: H31/34816/2013

Facilitator: Professor Irimu

 OBJECTIVES

 Introduction
 Nutrition in HIV vs. Nutrition in Non
HIV
 Exclusive Breast Feeding
 Complementary feeding
 Replacement Feeding- AFASS
 Food Security
INTRODUCTION
• In the absence of interventions, 5-20% of babies born to HIV-
infected mothers will acquire infection via breastfeeding.
• Interventions reduce risk of transmission to <5%.

• Among HIV infected women, aged 15-54,95.2% breastfed their

babies.

• This creates an urgent need to educate, counsel and support

women and families in making decisions on how best to feed their
infants in the context of HIV infection in the mothers.

Kenya AIDS Indicator Survey-2012

 Energy Needs of HIV Infected vs. Uninfected children (Kcal/day)
HIV HIV infected HIV infected Severely
Uninfected and and poor malnourished
Children asymptomatic weight gain and HIV
10% increase 20% increase infected 50-
100%
increase

6-11 months 690 760 830 150-220

kcal/kg/day

12-23 months 900 990 1080 150-220

kcal/kg/day

24-59 months 1260 1390 1510 150-220

kcal/kg/day

6-9 years 1650 1815 1980 75-100

kcal/kg/day

10-14 years 2020 2220 2420 60-90

kcal/kg/day
 Feeding Options for HIV Infected
Children

First 6 months
• Exclusive Breastfeeding with AZT (for 6
weeks)/Nevirapine (continued for 1 week after
breastfeeding is stopped) prophylaxis
• Exclusive Replacement feeding
After 6 months
• Introducing complementary feeds along with breast
milk or replacement feeds until a nutritionally
adequate diet can be sustained without milk
 EXCLUSIVE BREASTFEEDING

Exclusive breastfeeding means that an infant

feeds purely on Breastmilk WITH THE
EXCEPTION of ORS, vitamins, minerals or
drugs.
Factors that increase transmission
rates
• HIV disease progression
• Oral thrush in the infant prior to 6 months of age
• Breast pathologies
• Micronutrient deficiencies in the mother
• Recent infection with HIV

WHO. Nutrition. HIV and Infant feeding.

 Exclusive Breastfeeding
Points to emphasize during counselling:
• Proper technique
• Adherence to ART for the mother and Nevirapine prophylaxis for the
infant
• Compared to exclusive feeding, mixed feeding is linked to higher rates
of mortality, vertical transmission and morbidity among HIV exposed
infants. However, compared to replacement feeding, mixed feeding in
resource limited settings in the first six months of life is associated with
reduced morbidity among both HIV exposed and non-exposed infants.
• Maintenance of Breast hygiene
• Upon noticing any breast pathology, mother should stop breastfeeding
(but continue expressing) and seek medical advice
• IT IS ALWAYS BETTER TO BREASTFEED THAN NOT TO DO SO AS
LONG AS THERE IS HIV PROPHYLAXIS BEING ADMINISITERED
AS NECESSARY. An infant who is breastfed according to the WHO
guidelines has been proven to be healthier as compared to one that
isn't even in the presence of HIV.
 When and how to stop breastfeeding
• Stop at 1 year but may go up to 2 years as per guidelines
• Breastfeeding is gradually stopped over a time period of 2-3 weeks

Steps in transitioning
• Express breastmilk to accustom baby to cup feeding
• Gradually reduce breastfeeds and replace with EBM
• Change from EBM to replacement feeds
• If the baby is receiving EBM and replacement feeds simultaneously, the
milk should be heat treated
• Keep expressing to prevent engorgement until milk production stops
Complementary Feeding
• Defined as the process starting when breast milk is no
longer sufficient to meet the nutritional and energy
requirements of infants, and therefore other foods and
liquids are needed, along with breast milk.
• Complementary foods should be introduced at 6 months,
with continued breastfeeding or with replacement feeding
until 1 year or a nutritionally adequate diet can be
sustained without milk.
 Maternal Counseling Points
Mothers should ensure that complementary feeding is:
• timely: Introduced within 6 months
• adequate: provides sufficient protein, carbohydrates,
micronutrients to meet baby's needs
• safe: Hygienically prepared, fed and stored
• properly fed: Consistent with child's signals of appetite
and satiety

WHO (2016). Maternal, newborn, child and adolescent health. Updates on

HIV and infant feeding.
REPLACEMENT FEEDING

WHO defines replacement feeding as the process of feeding a child who is

not receiving any breast milk with a diet that provides all the nutrients
the child needs.
o During the 1st 6 months- suitable breast-milk substitute (commercial infant formula
milk, or expressed, heat-treated breast milk <e.g. where ARVs are temporarily not
available> with micronutrient supplements).
o After 6 months it should preferably be with a suitable breast-milk substitute
(commercial infant formula milk, animal milk <boiled for infants under 12 months>.
Meals, including milk feeds, other foods and combination of milk feeds and other
foods, should be provided four or five times per day.

NB: If suitable breast-milk substitutes are not available, appropriately

prepared family foods should be further enriched and given five times a day.

WHO (2016). Maternal, newborn, child and adolescent health. Updates

on HIV and infant feeding.
 CONDITIONS THAT NEED TO BE MET TO SAFELY FORMULA
FEED

 Safe water and sanitation are assured at the household level and
in the community.
 The mother or the caregiver can reliably provide sufficient infant
formula milk to support the normal growth and development of the
infant.
 The mother or the caregiver can prepare it cleanly and frequently
enough so that it is safe and carries a low risk of diarrhea and
malnutrition.
 The mother or caregiver can exclusively give infant formula milk
in the 1st 6 months.
 The family is supportive of this practice.
 The mother or caregiver can access health care that offers
comprehensive child health services.
WHO (2016). Guideline Updates on HIV and Infant Feeding. Page 8.
FOOD SECURITY

Food and nutrition security includes physical, social and economic access to food which
meets the dietary needs and food preferences for an active and healthy life.
Over 10 million people in Kenya are food insecure with majority of them living on food
relief.
(Food Security Report).
Components of food security according to WHO:
 Availability: Sufficient quantities of appropriate foods are available.
 Access: Adequate income or other resources are available to access appropriate food
via any means.
 Utilization: Food is properly used through appropriate food processing and storage
practices, adequate knowledge and application of nutrition and child care practices
and adequate health and sanitation services.
 Stability: Adequate food must be obtainable at all times so that access and availability
of food is not curtailed by acute or recurring emergencies (Sudden crises or seasonal
shortages).

WHO (2017). Nutrition. Food Security.

Kenya Agricultural Research Institute (2012). Food Security Report.
 FOOD SECURITY

Both food security and diet quality predict the nutritional status and quality of life among
people living with HIV with consumption of nutrient-rich foods being associated with better
immunological outcomes and being protective against HIV disease progression, MTCT and
mortality.
The relationship between HIV/ AIDS and food security is incredibly complex:
 Food insecurity is a risk factor for the spread of HIV, especially when coping behaviours
adopted to mitigate the negative impacts on food security (such as engaging in
transactional sex) increases the risk of HIV transmission and in the long run, the risk of
MTCT.
 HIV/ AIDS precipitates and exacerbates food insecurity and under nutrition by increasing
medical-related expenditures, reducing parental work capacity and jeopardizing
household livelihoods. Therefore, families unable to provide food security for their
children.
 Food insecurity and under nutrition among people living with HIV, in turn, compromise
adherence to treatment and hastens AIDS- related mortality, even among those receiving
ART.
 Inadequate complimentary feeds for the infant (due to food insecurity) leads to
malnutrition-infection cycle increasing risk of HIV acquisition via MTCT.

However, it is not to be forgotten the problem here is HIV/ AIDS infection which can be
reduced by community education on HIV prevention and the 4 prongs of eMTCT.
Layla Eplett (April 22, 2014). Food Security and the Fight Against HIV/ AIDS.
REFERENCES

• Kenya Agricultural Research Institute (2012). Food Security Report.

• Layla Eplett (April 22, 2014). Food Security and the Fight Against
HIV/ AIDS.
• WHO. Guidelines for use of breast-milk substitutes in emergency
situations.
• WHO (2016). Guideline Updates on HIV and Infant Feeding. Page
8.
• WHO (2010). Maternal, newborn, child and adolescent health.
Updates on HIV and infant feeding
• WHO (2016). Maternal, newborn, child and adolescent health.
Updates on HIV and infant feeding.
• WHO (2017). Nutrition. Food Security.
 NOTICE!
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COPY OF THE WHO/UNICEF GUIDELINES ON
BREASTFEEDING IN HIV (2016 EDITION)
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