Diet not an ARV substitute

There is no scientific evidence specific to South African conditions backing the use of nutrition as the primary treatment for HIV/Aids and Tuberculosis (TB), according to research released by the Academy of Sciences of South Africa (ASSAf) on Wednesday.

"The panel believes that nutrition is not a substitute for antiretroviral agents (ARV) in the treatment of those diseases," said research panellist Barry Mendelow, at the release of the study on nutritional influences on immunity in HIV/Aids and TB, at a press conference in Johannesburg.

"Does that mean nutritional treatment has no role - of course not. But we must understand the difference between primary and supportive treatment," said Mendelow.

Most of the available studies on the subject were conducted in North America and Europe among groups who were already well nourished and receiving treatment, so could not be applied in South Africa where the country faced an epidemic of malnutrition, HIV/Aids and TB.

Studies need to be local
Scientific evidence specific to South African conditions was urgently needed. There was a shortage of nutritionists in the country, as well as no specific chair dedicated to this particular field of study, panellists said.

Affordable tests on nutritional status needed to be devised and then conducted at clinics and more needed to be known about the interactivity of vitamins in the body.

Much of the population was malnourished or suffering from "hidden hunger", a condition where a person appeared to be well nourished but was actually deficient in nutrients.

"Let us for God's sake do these studies and come up with a useful recommendation," said Professor Wieland Gevers, a member of the report's study panel.

Guidelines good on paper
Nutrition expert Hester Vorster said the Department of Health's guidelines on nutrition were "excellent on paper" and had been used by the World Health Organization, but were poorly implemented because they did not have enough resources.

South Africa had a wide variety of foods and vegetables, “including beetroot" and the country already sold fortified maize meal and bread flour, she said.

Calling for a holistic approach to the diseases she called for additional resources for the implementation of the department's guidelines as well as legislation on claims relating to the medicinal benefits of certain plants.

"There are plants which may have beneficial effects but the evidence to recommend the use of these is still not there," said Vorster. "All caregivers should be working on an evidence base."

ASSAf panellist Jimmy Volmink said research showed that specific supplements such as amino acids could address the weight loss problems associated with HIV/Aids and increase body weight, but in HIV positive pregnant women, large doses of Vitamin A could increase the risk of mother to child transmission, and zinc could be harmful.

Vitamins can help
But multivitamins, excluding Vitamin A, could improve their outcome. However, for children, Vitamin A and zinc lowered the rate of diarrhoea and respiratory infections.

Vitamin D and good nutritional support helped prevent the development of TB in vulnerable groups such as the poorly nourished, families living with people with TB and health workers. But the interaction of treatment drugs and vitamins within the body also had to be considered.

Gevers said that despite the rigorous testing of medication, people were selling products under the heading "dietary supplements" without any kind of regulations.

"That double standard is something that must be addressed. People shouldn't make claims without good evidence. That it is safe to do so without any evidence is unethical and irresponsible."

The study is intended to be provided to policy makers. According to the SABC, Minister of Health Manto Tshabalala-Msimang had been handed an advance copy of the report.

Tshabalala-Msimang has been criticised for publicly focusing on the benefits of beetroot, garlic and lemons in the management of the disease, and underplaying the role of ARV's.

ARV treatment forms part of the government's treatment campaign but HIV/Aids activists believe not enough is being done in providing them to people who need them. – (SAPA)

Read more:
ARV rollout lagging
New HIV guidelines for adults

For more information on care and support of tuberculosis visit South African National TB Association (SANTA) or phone them on 011 454 0260.

August 2007

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