Nutrition and immune function in human immunodeficiency virus infection

The tried of human immunodeficiency virus (HIV) infection, nutritional stat us and immune function are intimately related, each factor having effects o n the others. The dominant effect in this three-way relationship is the eff ect of HIV infection on nutritional status, an effect which, until the adve nt of potent anti-retroviral drugs, has been manifest primarily as wasting. Recently, more complex metabolic abnormalities have become apparent, parti cularly fat redistribution syndromes, hyperlipidaemia and hypercholesterola emia. For the converse effect, the effect of nutritional state on HIV disea se progression, there is good evidence that clinical outcome is poorer in i ndividuals with compromised nutrition. However, the beneficial effects of n utritional support have been more difficult to demonstrate. For macronutrie nts, effective macronutrient supply improves survival in severely-malnouris hed individuals and may have beneficial effects in less-severely-affected i ndividuals. Micronutrient deficiencies appear to be involved in modifying c linical HIV disease and may also be associated with enhanced mother-to-chil d transmission of virus, particularly in developing countries. Intervention trials in this setting are currently under way. In conclusion, the interac tion of HIV infection and nutrition is of great importance not just because of the major impact that HIV infection has on nutritional state, but also because strategies to improve nutritional status, both quantitatively and q ualitatively, may have a beneficial effect on the clinical and immunologica l course of the disease.