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HIV & AIDS Treatment in Practice #1, 13 March 2003
A regular electronic newsletter for health care workers and community-based organisations on HIV treatment in resource-limited settings. It is supported by and produced in collaboration with St Stephen's AIDS Trust and the International HIV/AIDS Alliance.

Its publication is also supported by Positive Action of GlaxoSmithKline, Boehringer Ingelheim and the Access 4 Trust.
   Last updated: 18.06.04
IN THIS ISSUE
About HIV & AIDS Treatment in Practice
News links from www.aidsmap.com
Review: Living Well with HIV/AIDS (WHO/FAO nutritional handbook)
Co-trimoxazole Prophylaxis (main feature)

News links from www.aidsmap.com
A selection of news stories which have appeared since 1 March 2003.

Major PI-sparing study closes Trizivir arm due to inferiority to efavirenz arms
The US Department of Health and Human Services has written to HIV health care providers in the United States to inform them that an interim analysis of the ACTG A5095 study has found that patients who received Trizivir (AZT/3TC/abacavir) were significantly more likely to experience virological failure after an average of 32 weeks than participants randomised to receive either AZT/3TC/efavirenz or AZT/3TC/abacavir/efavirenz.

AIDS dissident appointment `last straw` in battle of activists and South African Health Minister
The Treatment Action Campaign has called for the removal of South African Health Minister Manto Tshabalala-Msimang for inviting an infamous AIDS dissident, Robert Giraldo, to become an adviser to her government on nutrition for people with AIDS. Giraldo believes that nutritional deficiencies, and antiretroviral drugs, are the cause of AIDS, rather than HIV.

Hepatitis not HAART causing serious liver toxicity in HIV patients
Severe liver inflammation and liver failure in people taking HAART is due to the effects of infection with hepatitis C or B, rather than the toxicities of anti-HIV drugs, according to a study conducted at the University of Brescia and published in the March 2003 edition of the Journal of Acquired Immune Deficiency Syndromes.

Diabetes risk increased threefold in HIV-positive women treated with PI
HIV-positive women taking protease inhibitors are three times more likely to develop diabetes than HIV-positive women on non-protease inhibitor combinations or HIV-negative women, according to a US study published in the March 2003 edition of the Journal of Acquired Immune Deficiency Syndromes.

UNAIDS and UNIFEM launch new website to address gender dimensions of HIV epidemic
Last month the Joint United Nations Programme on HIV/AIDS (UNAIDS), in association with the United Nations Development Fund for Women (UNIFEM) have launched a new gender and HIV/AIDS web portal (www.genderandaids.org) to provide researchers, policy-makers and practitioners access to cutting edge information.

High HIV viral load in breast milk within 14 days of delivery increases chances of infecting infant
HIV viral load in breast milk is highest during the first 14 days of lactation, and mother-to-baby transmission of HIV is most likely to occur during this period, according to a study published in 1st March 2003 edition of the Journal of Infectious Diseases. These findings are being hailed as “unique” by the study authors.

Good adherence predicts lipodystrophy in Italian cohort
Italian researchers have shown that people who adhered better to their antiretroviral therapy were at much higher risk of developing body fat alterations than people who did not always take their medication at the prescribed intervals, in a study published online this week by the Journal of Acquired Immune Deficiency Syndromes in a special supplement on adherence to anti-HIV therapy.

HIV lipodystrophy case definition: full details published
A lipodystrophy case definition developed by a working party convened by the European Medicines Evaluation Agency has been published in the March 1 edition of The Lancet.

Review: Living Well with HIV/AIDS
By Julian Meldrum

Subtitled ‘A manual on nutritional care and support for people living with HIV/AIDS’, this excellent online resource (available here) is a joint publication of two UN agencies, the WHO (World Health Organization) and FAO (Food and Agriculture Organization).

It is written for people who are directly involved in providing care for people living with HIV and AIDS and includes a series of handout sheets with practical advice on dealing with common problems relating to nutrition. There is also advice on the use of common herbs and traditional treatments, as well as discussion of macronutrients (energy, protein) and micronutrients (vitamins, minerals).

Specifically, the handouts cover: healthy and balanced nutrition; maintaining weight; food safety and hygiene; diarrhoea; loss of appetite; nausea and vomiting; having a sore mouth or throat; colds, coughs, sore throat and fever; looking after yourself in general; and some advice for carers on the need to look after themselves too.

The introduction stresses that the manual can be improved by adapting it to local circumstances, including dietary traditions and levels of access to treatment. It suggests ways this adaptation can be done, for example, through holding a workshop for professionals (such as health and agricultural extension workers) and people working in community organisations, including organisations of people with HIV where these exist, to consider the changes that are needed for local use, the product(s) that need to be developed and how they should be promoted. Checklists are provided to set an agenda for such processes.

The publication makes very little direct reference to medical treatment, since it has been written for use in many settings with widely varying levels of access to treatment. It has therefore been misrepresented by some as suggesting that nutritional intervention is an alternative to medical treatment or (worse) supporting the idea that AIDS in Africa is a crisis of malnutrition, which would disappear if people were adequately fed.

In fact, there is a clear statement in the manual that people living with HIV/AIDS have extra nutritional requirements, because of their illness. However, there is no special diet that can be guaranteed to keep people well. It is also clearly stated that the illness has a direct impact on people’s nutritional status as it can limit people’s appetite for food, even when supplies of food are adequate. The clear implication is that medical treatment is still required in addition to efforts by and help for individuals, families and communities affected by HIV and AIDS in meeting their nutritional needs.

The manual also observes that one of the aims of nutritional management is to maximise the benefit to individuals of medical treatment available to them. While the manual does not directly discuss the management of drug side effects, many of the recommendations in this manual are in fact practical ways to deal with such problems and the manual is a model of clarity in setting out how such advice should be presented.



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