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Malnutrition. Malnutrition among IDUs: Basic facts. Drug users are at increased risk of malnutrition regardless of whether or not they are infected with HIV

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    Presentation Transcript
    1. Malnutrition

    2. 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

    3. 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

    4. Malnutrition among IDUs: Basic facts • Malnutrition may impact the course of HIV-infection through a variety of mechanisms: • compromising host immune function • diminishing response to therapies • promoting co-morbidities

    5. 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

    6. Nutritional status of IDUs: India • Poor nutritional status in both HIV-positive and HIV-negative drug users • Nutritional status worse in HIV positive drug users • 52% of HIV-positive drug users and 50% of HIV-negative drug users having BMI levels below 18.5 kg/m2 • HIV-positive IDUs had significantly lower levels of fat mass, fat-free mass, and percent body fat than the HIV-negative IDUs • HIV-positive IDUs had lower cholesterol levels and higher triglycerides than HIV-negative IDUs Tang et al, 2011

    7. 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

    8. 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

    9. Anaemia

    10. 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

    11. Anaemia in HIV infected drug users • Anemia is a common clinical finding in HIV-infected 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

    12. 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

    13. 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