Diet and HIV: There is No Recovery without Quality Dietary Diversity

Without treatment, a person with HIV is expected to live for around nine to 11 years ¹³. With treatment, they can live considerably longer. When used correctly, antiretrovirals can slow disease progression by suppressing viral load to around less than 50 virus particles per ml of blood. It can also improve CD4 cell count to over 500 cells per mm³ of blood. However, the virus is not eliminated, and still lingers around in places like the gut, brain, and other areas. If treatment is stopped or compromised for any reason, the virus can re-emerge with a vengeance ¹².

Diet is one of the most significant yet understated factors that can influence treatment success in a person living with HIV. There is evidence that adherence to treatment is less likely when food insecurity is high, and diets are inadequate. In a study involving 390 HIV patients receiving treatment in Namibia, those experiencing severe food insecurity were over three times more likely to have low treatment adherence ¹⁸. In another study in urban Kenya, HIV patients were refusing free treatment offered, citing fears of experiencing side effects from taking the drugs on an empty stomach¹⁹. In Rwanda, interviewed patients mentioned having too much appetite without the food to satisfy their hunger it as a key barrier to maintaining treatment adherence²⁰. In rural Uganda, food insecurity was linked to non-adherence to treatment, incomplete viral suppression and having a CD4 count less than 350 cells/mm^{3 21}

Many African diets consist of a dominant cereal crop. In Southern Africa, this crop is maize. Low-income households generally spend a large portion of their food budget on maize, with other food items considered less of a priority. A monotonous maize diet can eventually lead to multiple nutrient deficiencies, which can hinder antiretroviral treatment efficacy ^{12, 18}. Nutrient deficient diets have also been linked to lower CD4 counts, increased viral loads and higher risk of mortality.

Being underweight has long been a predictor of mortality risk among HIV infected persons starting treatment. However, a person consuming a predominantly maize diet would eventually gain weight due to the high number of calories they were consuming. This may give a false perception that they were responding well to treatment. Meanwhile the lack of protein and micronutrients in such a diet will eventually weaken the immune system and increase the chances of developing an opportunistic infection. Therefore, a lack of dietary diversity can and should be a better predictor of the risk of developing an AIDS-related illness rather than a person simply being underweight. People with access to diverse diets providing adequate macro-and micronutrients have been shown to not only gain weight but achieve significant immune recovery whilst on treatment ²². This can contribute to slowing disease progression and allowing for recovery from any existing infections. Most importantly, it can help the person respond better to treatment, meaning improved efficacy and fewer side effects ²³. Guidelines from the World Health Organization (WHO) on the nutritional care and support of persons living with HIV already take this into consideration. Many of these documents have been around since the early 2000s. Yet there is little evidence of the practical application and implementation of these guidelines in HIV affected communities. This inherently needs to change.

Excerpt from “The Connection Between Maize and the HIV Epidemic in Southern Africa” – available on request.