Transcript Slide 1

Applying scientific thinking
in the service of society
AFRICAN SCIENCE ACADEMIES
DEVELOPMENT INITIATIVES (ASADI V)
8 – 12 NOVEMBER 2009
ACCRA, GHANA
ROBIN CREWE,
ACADEMY OF SCIENCE OF SOUTH
AFRICA (ASSAf)
HIV/AIDS, TB AND NUTRITION:
Scientific enquiry into nutritional influences on
human immunity, with special reference to HIV
infection and active TB in South Africa
(See at www.assaf.org.za)
BRIEF BY ASSAf COUNCIL
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(HIV, TB focus)
Impact of nutritional status on immunity
Impact of infections on nutritional status
Impact of nutritional interventions
Recommendations for policy and practice
Recommendations for research
HIV-NUTRITION CONTROVERSY- DAMAGING TO
S A AND PEOPLE
• Self-initiated consensus study
• Panel of 15 members (12 SA; 2 USA; 1 Tanzania), chaired by Barry
Mendelow
• Wide spread of expertise, perspective,etc
• Study Director : Boitumelo Mabina
• Think-tank meetings; commissioned drafting (internal, external);
forum-type workshop on HIV-gut relationship
• Report 300 pp plus; peer reviewed and revised;
• Released August 2007 in full and condensed versions; press/media
launch; govt.departments; dissemination of 3000 copies
Academy of Science of South Africa Consensus Study:
HIV/AIDS, TB, and Nutrition
• 14 members (2 US and 1
Tanzanian)
• Chaired by Professor Barry
Mendelow,
ASSAf member
• Duration – 18 months
• Workshop on HIV immunology of
the gut
• Ten recommendations
• Eight priorities for research
THE NATIONAL ACADEMIES
Advisors to the Nation on Science, Engineering, and Medicine
MAIN FINDINGS
• 3 Concurrent, inter-dependent pandemics
• Under-use of existing scientific knowledge
• Remarkable lack of reliable evidence (“the debate is so bitter because
the evidence-base is so small”)
• Lack of randomised, controlled trials (RCTs), as against many
observational studies; lack of embedded explanatory capacity: most
done out of context
Study released on the same day that the
following headline appeared:
Our Health Minister a “drunk and a thief”
Academy of Science of South Africa Consensus Study:
HIV/AIDS, TB, and Nutrition
• Extensive national and international media coverage
• Nhanhla Nyiade, spokesperson for the Department of Science
and Technology, told SciDev.Net that future briefings will be
carried out to incorporate the recommendations into
policymaking.
• ASSAf requested by DST to provide annual review of the state
of HIV/AIDS research
• Health Ministry spokesperson Sinbani Mngadi said the report
confirmed the correctness of the Health Department’s focus on
nutrition
• ASSAf continues conversations with the Medical Research Council
to realize a broader research agenda
THE NATIONAL ACADEMIES
Advisors to the Nation on Science, Engineering, and Medicine
HIV-NUTRITION CONTROVERSY- DAMAGING TO
S A AND PEOPLE
The KwaZulu-Natal Health Department is actively
promoting Aids denialists and quack Aids cures — with
the blessing of Health Minister Manto TshabalalaMsimang. Last Friday, the department hosted an
“information workshop on HIV treatment” at a Durban
hotel, where speakers condemned antiretroviral drugs
and called for traditional medicine to be promoted
instead. The meeting was opened by the KwaZulu-Natal
Health MEC Peggy Nkonyeni. Tshabalala-Msimang
delivered the keynote address. 18 May 2008
HIV/AIDS, TB and Nutrition: Special Considerations of Infancy
and Childhood;
Findings from the Academy of Science of South Africa Report
and its Impact on Policy
Findings of the Study
 South Africa is in the grip of three concurrent epidemics,
HIV/AIDS caused by the Human Immunodeficiency Virus, TB
caused by Mycobacterium tuberculosis, and malnutrition,
brought about by a variety of socio-economic factors.
 Although caused by separate factors, there is evidence that
each epidemic acts synergistically to aggravate the other two.
 Recent studies investigating the pathogenesis of HIV infection
have provided the paradigm-shifting insights that the
gastrointestinal tract is the anatomical front line of the
disease, and that lymphocyte activation is a key step in the
CD4+ T cell depletion that defines AIDS.
Findings of the Study Cont.
 Together, these insights have major implications for our
dawning understanding of the intersection between nutrition
and HIV/AIDS, both in terms of the potential impact of HIV
infection on nutritional status, and in redefining our
conceptions of how nutritional intervention might impact on
HIV/AIDS pathogenesis.
 Systematic review of the clinical literature has inter alia
identified macronutrient-related issues of importance in
relation to HIV infection in infants and pregnant mothers:
 Systematic review of the clinical literature has identified the
following micronutrient-related issues of importance in
relation to HIV infection in infants and pregnant mothers
Recommendations of the Study
 The possibility of augmenting standard school feeding
schemes and other childhood feeding schemes with ready-touse fortified, therapeutic foods, as an integral part of their
feeding regimens, should be actively explored in terms of cost,
feasibility, and general logistic requirements.
 Resources should be directed to ensure food security based
on locally available, affordable and traditional foods to
vulnerable populations.
 The nutritional care of people infected with HIV should focus
on diversified diets including locally available, affordable and
traditional foods, and should be complemented by appropriate,
locally acceptable macronutrient supplements.
Recommendations of the Study
 Promote and support adequate dietary intake of
micronutrients at RDA levels while recognizing that this may
not be sufficient to correct nutritional deficiencies in all HIVinfected individuals.
 In situations where micronutrient deficiencies are endemic,
these nutrients should be provided through food fortification
or micronutrient supplements
 HIV infected women should be offered multivitamin
supplementation at RDA levels.
 The existing legislation and regulations should be revised to
require adequate and controlled testing and evaluation of all
products claiming medicinal benefits with respect to HIV
infection or active TB.
Recommendations of the Study
Government should identify accessible, scientifically valid
ways to accelerate the investigation of promising traditional
or herbal products.
 An urgent national expert consultation should be
convened to develop national guidelines for infant feeding.
 More nutritionists and dieticians should be trained,
employed and utilized in all programmes addressing
HIV/AIDS and tuberculosis, and
 the nutritional knowledge of all health care workers in
community, clinic and hospital settings should be improved
and extended.
Recommendations for
Policy/Practice
• Implement and properly resource integrated national nutrition
programme
• Train, mobilise more nutritionists, dietitians
• Urgent national meeting of experts on breast-feeding of babies of
HIV-infected mothers
• Enforcement of regulations on all claimed medicinal benefits of nonARV agents
• Micronutrient supplements - food fortification important; judicious
use of (expensive) supplements, but never more than 1-2X RDA
The Challenge
All children are vulnerable, no matter the continent or
country or community into which they are born. But
African children face an additional and terrible challenge
that most children in the world will never know: the threat
of HIV and Aids. Graça Machel
Applying scientific thinking
in the service of society
THANK YOU
SIYABONGA
www.assaf.org.za
+27 12 349 6606