Nutrition and HIV/AIDS
UNICEF’s nutritional priorities for support to people infected or affected by HIV/AIDS are
threefold: helping HIV-infected mothers make informed infant-feeding decisions, supporting the
nutritional needs of children living with HIV and assisting the millions of children orphaned or
made vulnerable by the virus.
The UN estimates that:
• Globally, children under 15 accounted for an estimated 2 million of the estimated 33 million
people living with HIV in 2007.
• An estimated 2.7 million people were newly infected with HIV in 2007. Of these, 370 000 were
children under 15.
• An estimated 1.5 million pregnant women were living with HIV in low and middle income
countries in 2007
• Sub-Saharan Africa is home to 90 per cent of all children living with HIV, and women
represent nearly 60 per cent of HIV infections.
• In 2007, an estimated 2 million people died of AIDS-related causes. Approximately 270 000 of
these were children under 15.
• Fifteen million children under the age of 18 have lost one or both parents due to AIDS,
including nearly 12 million in sub-Saharan Africa.
Prevention of Mother to Child Transmission (PMTCT) of HIV and Infant Feeding
Every day about 1,000 children under the age of 15 years are infected with HIV. More than 90
per cent of these new infections occur during pregnancy, at the time of delivery, or during
breast feeding. In the absence of any preventative interventions, infants born to and breastfed
by HIV-infected women have roughly a one-in-three chance of acquiring infection themselves.
This can happen during pregnancy, during labour and delivery or after delivery through
breastfeeding. The risk of mother-to-child-transmission of HIV is about 15%–30% if the
mother does not breastfeed the child. With prolonged breastfeeding, the likelihood of infection
can be as high as 45%. Timely administration of a short course of antiretroviral drugs
significantly reduces the risk of HIV transmission. In 2007, an estimated 34% of pregnant
women living with HIV in low and middle income countries received antiretroviral regimens to
prevent transmission of the virus to their infants.
HIV-infected mothers face an agonizing choice when deciding how to feed their infants. If a
mother does not breastfeed, her infant will face a six times greater chance of dying in his or her
first two months of life from infectious diseases such as diarrhoea and respiratory infections.
Click on the link above to read more about HIV and infant feeding.
HIV’s high nutritional toll
The HIV/AIDS pandemic, combined with drought, floods, soaring food prices, decades of
conflict, economic decline and cuts in social services, have overwhelmed families in many parts
of sub-Saharan Africa, leaving them with few coping mechanisms. This crisis in Africa has
underscored the dire nutritional needs of all children who are HIV positive or affected by
HIV/AIDS, such as orphans and those living in households with infected family members. Many
are left to fend for themselves, while others live with HIV-infected parents who can no longer
provide food for their families. Undernutrition rates are increasing and orphans are hardest
hit. Without treatment almost 50 per cent of infected infants will die before age two. As of
December 2007, about 198,000 children globally were receiving antiretroviral therapy, up from
127,300 children in 2006 and 75,000 in 2005. Many HIV-infected children also suffer from
undernutrition.
UNICEF’s response
Fighting HIV/AIDS is one of UNICEF's five organizational priorities over the next four years.
Nutrition programming in the context of PMTCT is focused on the prevention of mother-to-child
transmission in breastfeeding and on care and support for infected mothers and HIV-exposed
and infected children. Strategies include: providing voluntary, confidential testing and infant
feeding counseling for pregnant women, helping governments develop infant and young child
feeding policies that encourage early and exclusive breastfeeding and include HIV guidelines,
protecting breastfeeding, and promoting optimal infant feeding in hospitals. UNICEF also
addresses the nutritional needs of the growing number of HIV-positive pregnant and lactating
women and children who are infected with the virus, orphaned, or living with an HIV-infected
parent. Read more in the page “HIV’s high nutritional toll”.
Interaction Between Nutrition and HIV in Children
The causes of compromised nutrition in persons infected with HIV are multifactorial and often
operate simultaneously. Inadequate macronutrient and micronutrient intake as a result of poor
appetite; malabsorption; nutrient diversion; and increased requirements caused by high viral load,
acute infection, fever, and altered metabolism may all contribute to delayed growth and
development, compromised immune function, and treatment failure in children.
The CDC defines wasting in HIV-positive adults as a 10% loss of body weight. In HIV-infected
children younger than 13 years, the CDC defines wasting as weight loss of more than 10% of
baseline; downward crossing of at least 2 percentile lines on the weight-for-age chart in a child
aged 1 year or older; or less than the 5th percentile on the weight-for-height chart on two
consecutive measurements at least 30 days apart, plus chronic diarrhea or documented fever for
at least 30 days, whether intermittent or constant.[4]
Research supports clinicians' intuition that the incidence of opportunistic infections is increased in
HIV-infected adults with a 5% weight loss.[5] If a 5% weight loss in adults has such deleterious
results, one can readily hypothesize that a child with a constant expectation to gain weight, and
fewer adipose and somatic protein reserves, would be even more adversely affected by
suboptimal weight. Therefore, promoting normal growth and avoiding weight loss or wasting
should be utmost priorities when caring for children with HIV infection or AIDS.