Staying healthy with hiv

Carbohydrates give you energy. To get enough of the right types of carbohydrates:

  • Eat five to six servings (about 3 cups) of fruits and vegetables each day.
  • Choose produce with a variety of colors to get the widest range of nutrients.
  • Choose legumes and whole grains, such as brown rice and quinoa. If you do not have a gluten sensitivity whole-wheat flour, oats, and barley may be ok. If you do, stick with brown rice, quinoa, and potato as your starch sources. If you are diabetic or pre-diabetic or have insulin resistance, then most of your carbohydrates should come from vegetables.
  • Limit simple sugars, such as candy, cake, cookies, or ice cream.

Fat provides extra energy. To get enough of the right kinds of fat:

  • Get 30% of your daily calories from fat.
  • Get 10% or more of your daily calories from monounsaturated fats.
    Examples: nuts, seeds, avocado, fish, and canola and olive oils
  • Get less than 10% of your daily calories from polyunsaturated fats.
    Examples: fish, walnuts, flaxseed, and corn, sunflower, soybean, and safflower oil
  • Get less than 7% of your daily calories from saturated fats.
    Examples: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils.

Vitamins and minerals regulate your body’s processes. People who are HIV-positive need extra vitamins and minerals to help repair and heal damaged cells. Eat foods high in these vitamins and minerals, which can help boost your immune system:

  • Vitamin A and beta-carotene: dark green, yellow, orange, or red vegetables and fruit; liver; whole eggs; milk
  • B vitamins: meat, fish, chicken, grains, nuts, white beans, avocados, broccoli, and green leafy vegetables
  • Vitamin C: citrus fruits
  • Vitamin E: green leafy vegetables, peanuts, and vegetable oils
  • Selenium: whole grains, nuts, poultry, fish, eggs, and peanut butter
  • Zinc: meat, poultry, fish, beans, peanuts, and milk and other dairy products

Because it is difficult to get enough of all the nutrients you need from foods, your health care provider may recommend a multivitamin/mineral tablet (without extra iron). Check the label to make sure it provides 100% of the recommended daily allowance (RDA). Discuss with your doctor what you’re taking — more is not always better. If you don’t eat at least three servings of high-calcium (green leafy veggies or dairy) foods each day, you might need to add a calcium supplement to your diet. This is becoming controversial however and more research is being done on this topic.

The inflammatory nature of HIV and AIDS puts those who have it at greater risk for infection, kidney failure and certain types of cancer. In addition to the damaging effects of the virus, side effects of some antiretroviral therapies also can predispose those with HIV to other conditions such as metabolic syndrome.

Nutrition is a valuable tool for people with HIV. Whether you have just been diagnosed, show no signs of illness or are in a more challenging stage of HIV, knowing what and how to eat can help keep your body and immune system strong.

Eating well can help:

  • Minimize symptoms associated with HIV.
  • Lessen the side effects of medications.
  • Increase your quality of life.
  • Improve your resistance to other infections and complications.

Healthy Eating When the Virus Is Under Control

Individual needs should be taken into consideration for those with HIV and AIDS; however, general healthful eating patterns are a good place to start.

  • Consume adequate calories throughout the day to maintain a healthy weight. Those with HIV/AIDS may have increased calorie and protein needs compared to those who do not have this condition.
  • Add protein to every meal. Protein is important because it is needed to make, repair and maintain cells in the body. It also plays a role in the immune system. Good protein sources include lean meats, poultry, fish, low-fat dairy foods, eggs, beans and lentils.
  • Include a variety of vitamin and mineral rich foods. Fruits, vegetables, whole grains, low-fat dairy and lean protein choices contain vitamins and minerals that help the body function. Zinc and vitamin C are used by the immune system and iron and vitamin B12 are essential for healthy blood cells. Including a variety of nutrient-rich foods helps meet these needs.
  • Discuss dietary and herbal supplements with your health care team. Ask about new supplements before starting them as some can interact with medications.
  • Be vigilant about food safety. Those with HIV/AIDS are more vulnerable to food poisoning because HIV weakens the immune system. Practicing food safety helps decrease your risk of getting sick. Avoid eating raw or undercooked meat, fish and eggs; only consume pasteurized milk or cheese; wash fruits and vegetables and remember to use separate knives and cutting boards for raw meats and produce.

When Eating is a Challenge

Diarrhea, nausea, vomiting, sore mouth and taste changes all are common issues that can develop with HIV and may make eating difficult.

The best therapy for these hurdles is to meet with a registered dietitian nutritionist. An RDN may already be on your health care team but if not, ask your doctor to refer you to one who is familiar with HIV/AIDS. An RDN can help you develop the right nutrition plan to get you through difficult periods.

Article

Review Journal of Rare Diseases Research & Treatment Open Access

CD4 count improvement as result of enhanced wellbeing of HIV/AIDS patients

Alfred Said Sife1, Tumaini Jonas Wapalila2 and Maulilio John Kipanyula3*

1Sokoine National Agricultural Library (SNAL), Sokoine University of Agriculture, P.O. Box 3022 Chuo Kikuu, Morogoro, Tanzania
2Morogoro Regional Commisioner’s Office, Boma Road, P.O. Box 650 Boma Road, Morogoro, Tanzania
3Department of Anatomy Histology and Cell Biology, College of Veterinary and Medical Sciences, Sokoine University of Agriculture, P.O.Box 3016, Morogoro – Tanzania

Abstract

The CD4 T-cell count is an important laboratory indicator of the immune status in patients with HIV/AIDS. It is used in decision making to determine when antiretroviral therapy and a need of prophylaxis for opportunistic infections should be initiated. This study was carried out to assess the contribution of donor funded projects to the wellbeing of people living with HIV/AIDS as measured by improvement of CD4 count. A total of 120 respondents were randomly selected from Morogoro urban and Kilombero district, Tanzania. Based on panel data, individual observations were made four times across time and there were a total of 480 observations. The home based care TUNAJALI project provided various interventions including medical care and psychological support with the purpose of improving the health status of people living with HIV/AIDS. The effect of home based care TUNAJALI services was the only predictor of health status of people living with HIV/AIDS that was measured as an improvement of CD4 count over time. The average CD4 count before, one year, two years of home based care, and during the study were: 193.86; 258.83 (25.1%); 375.72 (31.2%); 487.57 respectively. A positive relationship was observed between home based care services and well-being. The findings from the present study show that the home based care positively improved the well-being of HIV/AIDS patients in the studied population. Improved wellbeing also improved CD4 count in patients.

Introduction

The Acquired Immunodeficiency Syndrome (AIDS), caused by the Human Immunodeficiency Virus (HIV), constitutes one of the formidable challenges to human development1,2. It is a disease of the human immune system caused by infection with HIV which primarily infects cells such as Cluster of Differentiation 4 T helper cells (CD4+ T), macrophages and dendritic cells3. Two types of HIV have been reported and characterized – HIV-1 and HIV-2. HIV-1 was the first to be discovered and initially was referred to as LAV or HTLV-III. This strain is considered to be more virulent and more infective and responsible for majority of HIV infections globally. On the other hand, HIV-2 is largely confined in West Africa and it has lower infectivity4. HIV/AIDS has been in existence since 1981, and the number of people living with the diseases continues to grow. By the end of 2015, there were about 36.9 million people living with HIV globally, with 2.0 million new HIV infections occurring every year and 1.2 million HIV/AIDS-related annual deaths5. Sub-Saharan Africa (SSA) is the most affected region in the world having two thirds (25.8 million) of the global population living with HIV/AIDS6,7. In Tanzania, the first three cases of HIV were reported in 1983 in Kagera region and the epidemic had reached all regions in the country by the end of 1986. In 2012, around 1.6 million people (about six percent of the country’s population) were living with HIV in Tanzania8.

Along with other tests, the CD4 count which measures the number of CD4 T cells in the blood helps to tell how strong the immune system is and indicates the stage of HIV/AIDS and therefore guides treatment plans, and predicts the prognosis of the disease. While efforts to develop a vaccine and cure for HIV/AIDS are underway, to date efforts for mitigating its impacts depend largely on effective prevention, care and treatment strategies. Antiretroviral therapies (ARV), which can delay the disease progression, improve well-being and increase patient’s CD4 count7,9. In high-income countries, the availability of ARV has helped to improve health outcomes and maximise well-being among large numbers of people living with HIV/AIDS (PLWHA), thus transforming HIV/AIDS from a fatal disease to a manageable chronic illness. This is however not the case in poorer parts of the world, particularly sub-Saharan Africa, where the epidemic is most severe, due to partly limited or completely lack of access to ARVs. Keeping CD4 count high can reduce health complications from HIV/AIDS and extend patient’s life.

International efforts to combat HIV began in the first decade of the epidemic with the creation of the WHO’s Global Programme on AIDS in 1987. In 1996, UNAIDS was formed to serve as the United Nations system’s coordinating body and to help galvanize worldwide attention to AIDS. In 2000, targets to halt and reverse the spread of HIV by 2015 were established as part of the Millennium Development Goals (MDGs), and the World Bank launched its Multi-Country AIDS Program (MAP)10. Furthermore, the role played by the affected country governments and civil society is considered to be critical to the response. A number of donor funded programmes have been implemented to provide care and support services as a way of improving the well-being for people living with HIV/AIDS (PLWHA) in many African countries11,12.

This study was carried out to assess the contribution of donor funded projects to the wellbeing of people living with HIV/AIDS as measured by improvement of CD4 count due to home based care (HBC) and assistance from TUNAJALI project. The changes in CD4 count was strongly associated with improved wellbeing of PLWHA due to the assistance accrued from TUNAJALI project. Improved wellbeing remarkably correlated with improved CD4 count in patients.

Methods

The Tunajali Project

The TUNAJALI (“WE CARE”) was a donor funded project involved with HBC interventions for PLWHA, among other activities in Tanzania. The project operated in five regions in Tanzania namely; Coast, Dodoma, Morogoro, Mwanza and Iringa. The HBC services were designed to increase the uptake of counselling and testing services, especially targeting people who are the least likely to attend facilities due to poor access and fear of discrimination. In addition the HBC TUNAJALI project provided various interventions including medical care and psychological support with the purpose of improving the health status of PLWHA.Through the TUNAJALI project, the designated health facilities and community organizations in these three regions were provided with technical, managerial, and financial assistance. The project was implemented by Family Health International (FHI) and Deloitte and supported by USAID.

Study design: This study was conducted in November 2012 in Morogoro region in Tanzania. Morogoro is among the few regions in which the HBC TUNAJALI project operates. The study population comprised of all PLWHA supported by TUNAJALI project in the region. TUNAJALI staff in Morogoro region were also included in the study population. The study sample was obtained through a three level multistage sampling. First, two districts namely Morogoro Municipality and Kilombero were purposively chosen because they had high infection rates of 6.9% and 4.9% respectively (MRC, 2011). Second, eight wards, four from each district were selected based on the number of PLWHA that were supported by the project. The chosen wards were Lumemo, Michenga, Ifakara and Kibaoni Wards in Kilombero District as well as Mazimbu, Mafiga, Kihonda and Mzinga wards in Morogoro Municipality. Finally, convenience sampling was used to obtain 15 respondents in each ward, making a total of 120 respondents. Based on panel data, individual observation was made across time, each observation was made four times, thus there were a total of 480 observations.

Data Collection: Primary data were collected through structured questionnaire. Time series and cross-sectional design were employed in which data were collected at a single point in time (cross-sectional) but each individual observation was made across time (panel data). Panel data were obtained through retrospective questions (cross-sectional surveys by retrospective questions). Secondary data were obtained from various sources including TUNAJALI offices.

Data Analysis: Data were analysed using SPSS and STATA software. The following multiple regression model based on panel observations was employed in the analysis:

Yit = α + β1 X1 it + β2 X2i + β3X3it + T + λt ……….+ εit

Where;

Yit = CD4 counts or income of the ith individual observed in time t

X1it = The age of an individual i observed in time t measured in years.

X2i = Sex of an individual – 1 if an individual is a male

X3it =Marital status of an individual i observed in time t

T = 1, 2, 3 (number of times an individual attend HBC TUNAJALI services)

λt = 0 if an individual CD 4 Counts or income was measured for the first time,

1 if measured after the first time.

Ethics Approval and Consent to Participate: Permission to carry out this study was granted by the Morogoro urban and Kilombero district executive directors. Ethics approval for the study was given by the Ethical Committee of the Sokoine University of Agriculture (SUA), Morogoro, Tanzania. The Vice-Chancellor of the SUA issued a research permit on behalf of the Tanzania Commission for Science and Technology (COSTECH) that permitted the study to be carried out. Prior to data collection, verbal consent was obtained from each study participant after the purpose and importance of the study was explained. The respondents were assured that they could withdraw from the study at any time.

Results

Demographic characteristics

Age, sex, marital status, and education level were analysed to provide a snapshot on the background of the respondents (Table 1). An analysis of the background was particularly important because some of the characteristics were associated with well-being of PLWHA. The majority (69.2%) of the respondents were females. More than a half (56.7%) of the respondents aged between 30 and 45 years old confirming the fact that generally HIV prevalence is high in socially, economically and sexually active age groups. Over a third (35.8%) of the respondents were married and a quarter (25.8%) of the respondents were single. The great majority (86.7%) of the respondents had primary level of education. With regard to income generating activities, most (57.9%) respondents were engaged in petty trading. Slightly over half (51.7%) of the respondents had family sizes ranging from 4 to 6 persons.

Category Frequency Percent
Age in years
<18-29 7 5.8
30-45 69 57.5
46 and above 44 36.7
Sex
Male 37 30.8
Female 83 69.2
Marital status
Married 43 35.8
Divorced 3 2.5
Separated 20 16.7
Widow/widower 23 19.2
Single 31 25.8
Education level
Primary 104 86.7
Secondary 14 11.7
No formal education 2 1.7
Occupation
Petty trading 38 31.7
Crop production 30 25.0
Self employment 5 4.2
No employment 8 6.7
Petty trading and crop production 33 27.5
Crop production and self employment 4 3.3
Petty and livestock keeping 2 1.7
Family size
1-3 38 31.7
4-6 62 51.7
More than 6 20 16.7

Table 1

Background characteristics (n=120)

Activities Implemented by HBC TUNAJALI Project for the Well-Being of PLWHA

Information about the activities implemented by TUNAJALI was gathered through key informant interview with the project coordinator and review of project documents. TUNAJALI implemented several activities to provide psychological, health care, economic and legal support. Medical support was one of the services provided by the TUNAJALI project. For instance, a great majority (86.7%) of the respondents received medical support through drugs found in HBC kits. All respondents received of psychological support as nearly two thirds (62.5%) of the respondents were provided with home visiting and counselling as well as access to PLWHA groups to share experiences with colleagues about their HIV positive status. The rest (37.5%) were provided only with home visits and counselling. Seventy percent (70%) of the respondents were provided with material support in form of bed sheets, mosquito nets, soap and food supplements to assist them overcome economic challenges. Only a few (2.5%) respondents received legal support in the form of will writing and access to advocates. With regard to socio-economic support, 42.5% of the respondents joined the Internal Saving and Lending groups (SILC/CODET) established by the project. Fourty percent (40%) of respondents resumed their income generating activities as a result of improved health status (Table 2).

Type of support Frequency Percent
Drugs found in HBC kits 104 86.7
Medical support offered Drugs in HBC kits and transport fare 13 10.8
Drugs in HBC kits and referral to hosp 3 2.5
Total 120 100.0
Psychological support offered Home visiting and counseling 45 37.5
Home visiting and counseling & access to PLWHA groups 75 62.5
Total 120 100.0
Socio-economic support Linking to other financial institutions 4 3.3
Internal saving and lending groups SILC/CODET 51 42.5
Improved health status and be able to engage in income generating activities 48 40.0
None 17 14.2
Total 120 100.0

Table 2

Support services offered by HBC TUNAJALI project

CD4 Counts of PLWHA

The CD4 count measures the number of CD4 cells in a sample of blood. Along with other tests, the CD4 count is an important index on how strong the immune system is and it is often used as an indicator of the stage of HIV/AIDS. It guides treatment and predicts how the disease may progress. Therefore, maintaining the CD4 count high can reduce complications of the disease and extend life of PLWHA.

In order to study the changes in CD4 counts in PLWHA, respondents were asked about their CD4 counts before and after joining TUNAJALI project. Before joining the HBC TUNAJALI project the average CD4 count of the respondents was 193.86 and a year later, the average CD4 count improved to 258.83. Two years after joining the project the average CD4 count rose to 375.72 during this study, the average CD4 count of the respondents was 487.57. Change of CD4 count was obtained by comparing the counts before and after joining TUNAJALI services. A large proportion of PLWHA included in this study were on ARV therapy, however majority did not adhere to treatment regime until when HBC was introduced. The HBC TUNAJALI project intervention involved, provision of medical care and psychological support with the purpose of improving the health status of PLWHA. Furthermore the intervention resulted into adherence to medical prescriptions including ARVs. Improvement was measured in terms of improvement of health status and CD4 counts.

Furthermore TUNAJALI HBC project ensured that clients are enrolled as early as possible into care and treatment programmes. The implementation of HBC heavily relied upon volunteers and the impact of HBC was magnified by the provision of home care kits to help with immediate medical, hygienic, and nutritional needs. The kits include items such as bed nets, water purification tablets, micronutrients, and pain-relieving and other essential drugs. Other clients especially those residing far away from CTC were in addition supported with fare to access health facilities. The HBC volunteers also accompanied PLWHA during hospital visits. This strategy ensured consistency and bridged the gap between the hospital and other clinical services patients needed. During this study, the average CD4 count of the respondents was 487.57. The results presented here clearly show that the average CD4 of the respondents significantly increased as the client’s years of receiving services from HBC TUNAJALI project increased. Based on these data the HBC TUNAJALI Project interventions are likely to have influenced positively to improve the health status of PLWHA.

Contribution of HBC TUNAJALI Project to the Well-being of PLWHA

Determining the contribution of project activities was achieved by using regression analysis of panel data. Panel data (also known as longitudinal or cross sectional time-series data) is a dataset in which the behaviour of entities is observed across time. Panel data allow one to control for variables that cannot be observed or measured such as cultural factors or variables that change over time but not across entities. The pooled regression result as well as the fixed effects and random effects regression results are summarized in Table 3.

Table 3

Pooled Ordinary Least Square (OLS) result of HBC TUNAJALI project on Health status of PLWHA

Pooled Ordinary Least Square (OLS) results presented in Table 3 acts as a preliminary model to show relationship between variables and the key assumption is that individual effects do not exist. The result from the pooled OLS can seldom be taken to be final as we did not check weather individual effect existed or not. With regard to the health status of PLWHA, regression was significant (p≤ 0.05) and the eleven independent variables accounted for 38% (Adjusted R2 = 0.381) of variation in health status of PLWHA. The results also showed that three of the eleven independent variables (age, education level and TUNAJALI services) included in the analysis had significant (p ≤ 0.05) regression coefficients and all the three variables showed positive regression coefficient. This implies that age, education level and TUNAJALI services effect had positive relationship with health status of PLWHA.

Fixed effect model assumes that something within the individual may impact or bias the predictor or outcome variables, and this should be controlled. Table 4 presents the fixed effect and random effect results. Fixed effect removes the effect of those time-invariant characteristics from the predictor variables and hence the predictors’ net effect can be assessed. Random effect assumes that the variation across entities is random and uncorrelated with the predictor or independent variables included in the model. The dropped variables indicated in Table 4 are those time invariant characteristics which are removed in fixed effect model so as to determine predictors’ net effect.

Table 4

Fixed and random effects results of HBC TUNAJALI project on Health status of PLWHA

In order to choose Fixed Effect (F.E) and Random Effect (R.F), the Housman test was conducted. The Housman test accepts the null hypothesis of no systematic difference in coefficient between the F.E and R.E (P=0.322). Therefore, the random effect model was opted for and the result was discussed by random effect model. The results from the random effect model showed that attendance to TUNAJALI project was responsible for PLWHA health improvement. This was further verified by comparing the CD4 counts in the successive periods of joining the TUNAJALI project using a paired sample t-test. Table 5 indicates that in all four pairs of successive periods of joining the project, a preceding period had on average low level of CD4 counts compared to the next period, in each case p-value was equal to 0.000.

CD4 Mean t df Sig. (2tailed)
Pair 1 CD4 for the first time since joined HBC TUNAJALI – CD4 one year since joined HBC TUNAJALI Before- 193 5.688 119 0.000
One year-258
Pair 2 CD4 one year since joined HBC TUNAJALI – CD4 two years since joined HBC TUNAJALI Before-258 -10.251 119 0.000
Two yrs-375
Pair 3 CD4 two years since joined HBC TUNAJALI – current CD4 Before-375 -9.614 119 0.000
Current-487

Table 5

Paired sample t-test result for CD4 count changes and HBC TUNAJALI services over time

Furthermore, slightly over half (51.7%) of the respondents admitted that HBC TUNAJALI Project was responsible for their change from bedridden patients to the healthy persons able to do anything, rise of their CD4 as well as awareness about living positive and free from opportunistic infections (Table 6).

HBC TUNAJALI responsible to the Health status Frequency Percent
Rise of CD4 1 0.8
Aware of living positive 4 3.3
Rise of CD4 and change from bed ridden 2 1.7
Rise of CD4 and aware of living positive 48 40.0
Change from bed ridden & aware of living positive 3 2.5
Rise of CD4, change from bed ridden and aware of living 62 51.7
positive
Total 120 100.0

Table 6

Effect of HBC TUNAJALI Services on Health status of PLWHA

DISCUSSION

The CD4 T-cell count (CD4 count) is an important tool and the major laboratory indicator of the immune status in patients with HIV/AIDS. It is therefore used in decision making to determine when antiretroviral (ARV) therapy initiation and the need for prophylaxis for opportunistic infections should be prescribed. The CD4 count response following ARV therapy and improved wellbeing varies widely among HIV/AIDs patients and a poor response represents a severely compromised immune system. The absolute CD4 count is a calculated value derived from total white blood cell (WBC) count and the percentage of total and CD4+ T lymphocytes. The count is an absolute number that may fluctuate in individuals or may be influenced by factors that may affect the total WBC count and lymphocyte percentages. In that context it is also the strongest predictor of subsequent disease progression and survival according to findings from clinical trials and cohort studies13,14.

Generally, the provision of medical support has been considered as an important factor for improving the wellbeing of PLWHA. Previous studies7,15 have also shown that the life of PLWHA depends on effective prevention, care and treatment strategies, including ARV, which can delay the disease progression, improve well-being and increase life expectancy. In this study the HBC TUNAJALI services effect was the only predictor of health status of PLWHA and was measured in terms of improvement of CD4 count. Previous studies have shown that an adequate CD4 response for most patients on therapy is defined as an increase in CD4 count in the range of 50 to 150 cells/mm3 per year, generally with an accelerated response in the first 3 months of treatment14. However, this has never been the case when patients are prescribed with ARV alone without social wellbeing support services16,17. Consistent with previous studies we observed a sustained increase of CD4 counts over time, which to a large extent was attributed to improved wellbeing from the HBC TUNAJALI services. The positive regression coefficient implied that TUNAJALI services effect and health status of PLWHA were positively related. Increased attendance to TUNAJALI services led to improved health status and CD4 count of PLWHA. These findings were similar to the studies among HIV infected persons in high-income countries that documented a positive relationship between social support and health outcomes18,19.

The HBC TUNAJALI intervention activities positively improved the health status and income of PLWHA in the studied population in Morogoro region. The project interventions enabled PLWHA to resume to their daily activities and engage in productive activities which concurrently improved their well-being. The main interventions implemented by HBC TUNAJALI to improve well-being of PLWHA included; health care support, psychological support to enable PLWHA to cope with their HIV positive status and thus enhanced the positive living attitude, socio-economic and legal support. Furthermore, the HBC TUNAJALI project also facilitated establishment of saving and Internal Lending Community services (SILC). The SILC provided capital to PLWHA to initiate income generating activities in form of soft loans. Certainly, the findings from this study indicated that respondent’s sex, age, marital status, family size, occupation and education level did not significantly influence the health status of PLWHA. According to Adedemeji10, psychological issues that dominate the lives of PLWHA impact heavily affect their well-being. Constant worry, stress and anxieties about their future can contribute to poor health outcomes and may become catalysts for adopting ill health-enhancing behaviors. It is for that reason that psychological support played an important role in enhancing well-being of PLWHA in the studied population.

Although a positive relationship between HBC TUNAJALI project intervention activities and well-being of PLWHA were realized in the present study, sustainability issues related to well-being of PLWHA was observed as one of the major constraint affecting PLWHA supported by the donor funded projects. Some of PLWHA showed overdependence to the HBC TUNAJALI support activities threatening their well-being beyond the project duration. Stigma from the community members following disclosure of HIV status and inefficient remuneration of volunteers for the activities also affected the delivery of HBC TUNAJALI services to PLWHA. It is conceivable that the model used by the HBC TUNAJALI project by establishing and engaging PLWHA in income generating activities, can be used as a showcase to prepare PLWHA to sustain their well-being once donor funded supports reached an end. Furthermore, despite the constraints revealed in this study, it is evident that if well implemented, Donor Funded Projects are likely to improve the well-being of PLWHA.

Study Limitations: This study had several limitations. It was not possible to follow trends over a short period of time because data were collected at a single point in time, thus making it difficult to measure changes in the population. Also, convenient sampling may not have represented the entire population. The study might also suffer from recall bias, social desirability recall, and self-report bias. However, some measures were taken to reduce recall by asking few questions that required recall.

Conclusion

HIV/AIDS has caused immense human sufferings by affecting nutrition, livelihoods and well-being of individuals, households and affected communities at large. Several donor funded projects have to been instrumental to provide care and support services to improve the well-being for PLWHA. The findings from the present study showed that the HBC TUNAJALI Project positively improved the well-being of PLWHA in the studied population in Morogoro Region. Improved wellbeing also improved CD4 count in patients.

Considering a large number of PLWHA in the Morogoro and other regions in Tanzania more civil society organizations, government institutions and private sectors should be engaged in provision of care and support services to PLWHA.

Acknowledgements

This study was funded by Sokoine University of Agriculture.Technical support from TUNAJALI Project is highly appreciated.

Abbreviations

ARV: Antiretroviral

CD4+ T: Cluster of Differentiation 4 T helper cells

FHI: Family Health International

HBC: Home Based Care

HIV/AIDS: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

PLWHA: People Living with HIV/AIDS

TACAIDS: Tanzania Commission for AIDS

UNAIDS: Joint United Nations Programme on HIV/AIDS

USAID: United States Agency for International Development

WHO: World Health Organization

Authors’ contributions

MJK carried out the study design, participated in data analysis and drafted the manuscript. ASS participated in the design of the study and drafted the manuscript. TJW conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

8 Health Tips for Managing HIV

When you’re living with HIV, it’s more important than ever to protect your immune system to maintain overall health. By keeping your body as healthy as possible, it’s much better equipped to fight off viruses and other types of infections, says Kristin Englund, MD, associate staff member of the department of infectious disease at the Cleveland Clinic in Ohio.

People living with HIV need to incorporate healthy habits into their lifestyle. Follow these eight tips for healthy living with HIV:

1. Practice safe sex. This is paramount on the list. Says Dr. Englund, “Practicing safe sex is essential.” Understand how the virus is transmitted to reduce the risk of infecting others. Use condoms not only to avoid the spread of HIV, but also to protect both you and your partner against other sexually transmitted diseases (STDs) and other types of infections.

2. Get tested for other STDs. If you have another STD, also known as sexually transmitted infections, or STIs, you may be more likely to transmit both HIV and your other STD to someone else. STDs can also worsen HIV and make the disease progress more rapidly. And HIV can make STDs more difficult to treat, so you’ll want to address an STD as soon as possible. Getting tested is a must because many STDs don’t cause any symptoms — without testing, you may not even realize you have one.

3. Prevent infections and illnesses. Since HIV makes your immune system less effective, you become more susceptible to every virus, bacteria, and germ you’re exposed to. Wash your hands frequently, and stay away from sick people to stay as healthy as possible. Also stay up-to-date on all of your vaccinations to reduce your risk of preventable illnesses.

4. Follow doctor’s orders about your prescriptions. It’s crucial to take your HIV medication exactly as prescribed by your doctor. Skipping even one day of medication can give the virus an opportunity to become resistant to the drugs, making them ineffective against the virus, says Englund. Be sure to take prescriptions at the same time every day, and always have your medication with you so that if you are away from home, you won’t have to miss a dose.

5. Don’t abuse drugs or alcohol. Alcohol and drug overuse can contribute to feelings of depression. Avoid illegal drugs and take prescription drugs as directed by your doctor to help protect your immune system. Avoiding drug abuse can also help to prevent cognitive (thinking and reasoning) impairment, which is important in minimizing HIV-related dementia.

6. Quit smoking. Giving up cigarettes is beneficial for anyone. Stopping all tobacco use will help you live healthier and feel better, according to Englund, as well as prevent a number of health problems and reduce your risk of serious events like heart attack and stroke.

7. Manage physical and emotional health problems. Depression is common among people with HIV, and the stress associated with having HIV can worsen depression symptoms. What’s more, both stress and depression can worsen physical pain associated with HIV. Keeping stress, depression, and pain under control can help improve your physical and emotional health, making life with HIV easier. See a mental health professional if you feel you’re experiencing depression, and be sure to mention that you’re taking medication for HIV to avoid potential drug interactions between depression and HIV medicines.

8. Exercise mind and body. Physical and mental exercise can keep your mind and body strong. Regular physical exercise, such as walking, biking, running, swimming, or another activity you enjoy, keeps you physically fit and can keep both stress and depression in check. Physical exercise significantly helps the immune system as well. Mental exercise — doing a daily crossword puzzle or playing brain-challenging games — can help maintain your cognitive health. Exercise your memory, concentration, and attention, all of which can be affected by HIV.

The keys to staying healthy with HIV are within your control. Live a healthy lifestyle. Fuel your body with a healthy, nutritious, and balanced diet, and allow it to recharge each night with enough quality sleep. Treat your body well to strengthen it, so that it can defend against illnesses that could threaten your health.

How to stay healthy when you’re HIV-positive

If you are living with HIV, it’s essential that you take extra care of your health as your immune system is extremely vulnerable. This is because HIV reduces the immune system’s ability to protect the body from viruses and bacteria. It’s also common knowledge that the immune system needs good nutrition to function well. So, for individuals living with HIV, it’s even more important to be health-conscious.

Eat nutrient-rich food

First on the list is following a healthy diet, eating a variety of nutrient-rich foods daily so the body gets enough carbohydrate, proteins and fats, as well as important vitamins and minerals.

Dr Jireh Serfontein of My Sexual Health, a clinic in Pretoria, explains that a Mediterranean diet is a great guide in this regard: “It’s well known that people in the Mediterranean eat a diet rich in vegetables, fruit, legumes and grains plus moderate amounts of chicken and fish. They eat little red meat and most fats are unsaturated ones from olive oils and nuts.”

A good diet can be challenging…

Living with HIV means you may find it difficult to follow a good diet. One reason is opportunistic infections. They can cause diarrhoea and/or vomiting and thus impair the body’s ability to absorb important nutrients.

“Candida, an opportunistic infection in the mouth or throat, for instance, can lead to pain when swallowing, and thus prevent an individual from eating properly,” says Dr Serfontein.

Another potential barrier to good nutrition is medication as some of the side effects of antiretrovirals (ARVs) are diarrhoea and vomiting, although they do diminish over time. On the other hand, if the HIV is not treated and the patient gets AIDS, the virus itself causes damage to the intestinal tract. This results in impaired absorption as nutrients are lost through damaged intestinal walls.

Still, it is important to keep focused on getting as much good nutrition into your body as you can, so perserverence is key. Consult your doctor or clinic if you are struggling to find a balance or experiencing any of these setbacks.

Get vaccinated

HIV can also affect an individual’s health in other ways. The HI-virus causes immune dysfunction, putting the HIV-positive individual at risk of getting other infections like pneumonia, tuberculosis (TB), and meningitis. If you are on ARVs, the risk of these infections is low but it is important to make sure that your immunisations are up to date.

“Ask your doctor for the following: pneumococcus vaccine, hepatitis B vaccine, diphtheria, whooping cough and annual flu vaccines,” says Dr Serfontein. Speak to your Clicks Clinic sister or pharmacist about vaccinations that are available to you and book an appointment for them by visiting Clicks Clinics online.

Stay heart-healthy

The other critical health issue regarding living with HIV is the risk of heart attack or stroke, which is much higher in HIV-positive individuals compared with those who are HIV-negative, even if you are on ARVs.

There are several well-known factors that increase the risk of stroke and heart attack. These include hypertension, smoking, diabetes, high cholesterol, being overweight and a lack of physical activity. It’s therefore very important not to smoke and to manage hypertension, diabetes and high cholesterol optimally, if you are HIV positive. This means eating a balanced diet, maintaining a healthy weight (your Body Mass Index, or BMI, needs to be less than 25) and exercising at least three times a week.

Avoid knocking back the alcohol

Alcohol is also potentially dangerous if you are HIV-positive. Some studies have shown that excessive alcohol use has a negative effect on your CD4 count, hastening the disease progression of HIV. It can also contribute to the spread of HIV by impairing one’s judgement which in turn leads to risky sexual behaviour. Additionally, alcohol use can also make it difficult to take ARVs as prescribed.

How Clicks Clinics can help you

Did you know Clicks offers HIV testing and counselling at our clinics? To make an appointment at a Clicks Clinic, call 0860 254 257 or book online at Clicks Clinics online.

HIV home test kits are also available for purchase in-store.

Shop online at Clicks.co.za for condoms

Don’t be caught unawares – rather stock up on condoms via the convenince of online shopping so that you can ensure you’re practising safe sex at all times.

IMAGE CREDIT: 123rf.com

An HIV diagnosis was once a death sentence, but that is no longer the case for those of us who stay healthy. In fact, the average HIV-positive person today is expected to live to be nearly 80, roughly on par with the general population. As more and more people reaching the century mark, here’s a list of the best things you can do — besides adhering to your medication regimen — that’ll help you have a long, healthy life.

1. Keep Your Head in the Game

Depression, stress, and anxiety are tough for people to overcome, but these conditions can also harm your immune system. Psychotherapist Melissa Lopez works with her HIV-positive patients to develop a plan once their moods start to sour. ”When you’re already working with a compromised immune system, pre-depression or anxiety can bring on a lack of motivation,” she says, which can lead to people slacking on their meds. Lopez suggests finding a professional counselor, especially when you’re first diagnosed with HIV, to form a plan to deal with anxiety, depression, or other negative feelings. ‘

‘Know the symptoms of depression, know the symptoms of anxiety, so you know what’s happening to you,” she says. ”You have to be proactive to prevent another, deeper cycle of depression.”

2. Beat Back the Blues

Even when things don’t seem like they’re going your way, looking at things with a positive attitude may be enough to help you get through a tough situation, and even live longer. One study indicated that people in their 20s who used mostly positive, affirmative words to describe themselves were more likely to live into their 80s than those with negative outlooks. Additionally, people with a more positive view of life tend to have fewer strokes, coronary problems, injuries, and colds, and positive-thinking women have healthier pregnancies.

3. Nurture Your Gut

The lymphoid tissues in a person’s stomach are filled with T cells. Because HIV affects T cells, many people with HIV have gastrointestinal problems, but a healthy GI tract is crucial to proper absorption of antiretroviral medication. Some anti-HIV meds need to be taken with food to assure this absorption and avoid potential side effects such as diarrhea. Many HIV-positive folks could also benefit from probiotics and a high-fiber diet, APLA’s expert Brian Risley says.

Pages

  • 1
  • 2
  • 3
  • 4
  • 5
  • last “

Healthy Lifestyle Choices for People With HIV

An HIV diagnosis can turn your whole life upside down. Just as you become alert to HIV symptoms and find yourself faced with a new routine of doctor’s visits and medications, you may also want to make some healthy lifestyle changes that can improve your health and quality of life. Start by:

  • Eating a more nutritious diet. This can:
    • Help you remain healthier overall despite your HIV infection.
    • Slow down the progression of HIV to AIDS.
    • Help prevent health problems related to malnutrition.
    • Help you maintain a healthy weight and avoid the excess weight loss that can occur in HIV-infected individuals.

      A healthy diet for someone living with HIV is one that is rich in whole grains, low fat dairy products, protein, and lots of fresh fruits and vegetables. Include multivitamins, especially B12 and zinc, wherever possible. Remember that a healthy diet is also about what you don’t eat: Try to cut out fried foods and sugary drinks as much as you can.

  • Quitting smoking. According to the CDC nearly 18 percent of adults in the United States smoke — that rate is two to three times higher in adults with HIV. Syracuse University researchers analyzed data from 212 adults with HIV and found that people with HIV who smoked also reported having more symptoms such as coughing and dizziness.
  • Stopping illicit drug use. If you are using illegal drugs such as cocaine, heroin, or methamphetamines, seek treatment for your addiction. Sharing needles to use such drugs can leave you vulnerable to other infections such as hepatitis, and that may lead to more rapid progression of HIV to AIDS. Illegal drug use could also affect the HIV disease itself. A recent study from the University of Pennsylvania School of Medicine demonstrated a dramatic increase in the ability of HIV to attack healthy cells when methamphetamine is present in the bloodstream. If you do continue to use injectable drugs, do not share needles with others.
  • Getting moderate exercise. Being physically active three to six times a week can help improve your mood and your outlook as well as improve your overall quality of life. The benefits of exercise include fighting HIV symptoms of appetite loss and nerve pain, and reducing the risk of other chronic diseases such as diabetes, heart disease, and osteoporosis.
  • Practicing safer sex. Having HIV does not mean the end of your sex life — but you should always use a new latex condom whenever you do engage in sex. This will protect your partner from your HIV infection and will protect you from sexually transmitted diseases (STDs) that can complicate your health status.
  • Getting tested and treated for sexually transmitted diseases. Many people with HIV also have other STDs, even if they are asymptomatic. Get tested to find out if you have any other infections and get treated if you do.
  • Taking your medications as prescribed and visiting your doctor often. Your doctor may have prescribed HIV medications to help your body’s immune system stay healthy longer. Taking those medications as prescribed, even though it may be difficult to keep up with the medication schedule, is extremely important. Taking medications on schedule is called adherence — it is important because it will reduce the risk that HIV will become drug resistant and it will also give your body the best chance at keeping the virus under control.
  • Taking steps to prevent infections. If you have HIV, you can get infections more easily. Many of the healthy lifestyle steps above will help you avoid infections — for example, quitting smoking removes a significant contributor to lung infections. There are some other steps you can take to reduce common causes of infection, such as washing your hands well and often, practicing good food safety to avoid foodborne illness, and staying current on recommended vaccines.

Making these changes in your life will help you stay healthier longer, even with HIV.

Healthy eating for people living with HIV

Dietitians can:

  • Make sure your diet is fulfilling all your individual nutritional requirements.
  • Give you advice about your diet if you are experiencing metabolic changes due to your HIV treatment.
  • Regularly check your body weight and ensure that the proportion of fat to muscle is appropriate.
  • Advise you on any dietary changes you may need to make if you become ill.
  • Help you avoid food poisoning.
  • Offer advice on symptom control, such as how to manage changes in taste caused by medication.
  • Give advice for managing conditions such as diabetes, obesity, hyperlipidaemia (high levels of fat in the blood) and poor absorption of food.
  • Give advice on your nutritional requirements during pregnancy.
  • Help you identify and manage any food allergies and intolerances.
  • Advise you on your nutrition needs based on your exercise levels or sporting activity.
  • Provide information and advice on the use of vitamins and minerals and complementary therapies.

Some dietitians use a variety of tests to assess how much muscle and fat there is in your body. If these tests are done regularly your dietitian may be able to spot changes in weight and body composition before you do. However, you may be the first to notice changes in your weight or body shape – for instance, if your clothes become too loose or tight. These may be important times to talk to your dietitian about making changes to your diet or exercise.

There’s no specific eating plan for people with HIV, but an overall healthy diet can help your health a lot.

The virus weakens your immune system. Because your body uses nutrients to keep up its defenses against germs, eating well can help you fight off infections. It can also boost your energy, keep you strong, help you avoid health complications, and ease issues brought on by HIV and its treatments.

Follow these simple tips to get started.

1. Eat plenty of fruits and vegetables. They’re high in nutrients called antioxidants, which protect your immune system. Aim to have five to nine servings of produce each day. An easy way to meet that goal is to fill half of your plate with fruits and veggies at each meal. Eat a lot of different produce to get the most vitamins and minerals.

2. Go for lean protein. Your body uses it to build muscle and a strong immune system. Choose healthy options like lean beef, poultry, fish, eggs, beans, and nuts.

You may need to eat more protein if you’re underweight or in a later stage of HIV. Your doctor can help you figure out the right amount for you.

3. Choose whole grains. Like gas in a car, carbs give your body energy.

That makes whole-grain carbs, like brown rice and whole wheat bread, high-end fuel.

They’re packed with energy-boosting B vitamins and fiber. And when you eat plenty of fiber, that can lower your chances of getting fat deposits called lipodystrophy, a potential side effect of HIV.

4. Limit your sugar and salt. Whether because of the virus or the treatment drugs you’re taking, HIV raises your chances of getting heart disease. Too much sugar and salt can harm your ticker. So aim to get less than 10% of your calories each day from foods and drinks with added sugar. You should also have no more than 2,300 milligrams of sodium per day.

5. Have healthy fats in moderation. Fat provides energy, but it’s also high in calories. If you’re not trying to gain weight, limit how much of it you eat. Heart-healthy choices include nuts, vegetable oils, and avocado.

Diagnosed with HIV at a low CD4 count

Key points

  • A low CD4 count means that HIV has damaged your immune system and may be making you ill.
  • HIV treatment will strengthen your immune system and extend your life.
  • While your CD4 count is low, you may also need to take antibiotics to prevent infections.

HIV treatment is recommended for everyone who has HIV, but it is especially important for people with a low CD4 count. This indicates that HIV has damaged their immune system to such an extent that they are at risk of serious illnesses.

Every year several thousand people learn that they are HIV-positive when their CD4 count is already below 350 (two in five of all people diagnosed in the UK in 2014). HIV may be making them ill, or they may have another condition associated with HIV.

If you are diagnosed with HIV with a low CD4 count, you will be recommended to start HIV treatment very soon or even straight away. You may need additional treatment and monitoring, but there is a good chance that you will respond well and your immune system will start recovering.

The immune system and HIV

The immune system’s different cells work together to protect the body against pathogens such as viruses and bacteria.

The human immunodeficiency virus (HIV) mainly infects the CD4 cells in the immune system. Over years of HIV infection, CD4 cell numbers usually drop gradually, but constantly, and the immune system is weakened. If nothing is done to slow or halt this destruction, it becomes unable to fight infections and you become ill.

Antiretroviral drugs interrupt this process. The aim of treatment is to reduce levels of HIV (often called your ‘viral load’), so your CD4 count increases and your body’s ability to fight infections improves.

Starting HIV treatment after diagnosis

The sooner you start to take HIV treatment, the sooner you can benefit from it. HIV treatment will strengthen your immune system, reduce the amount of HIV in your body and prevent illnesses from occurring. Effective HIV treatment also helps prevent you from passing HIV on to someone else.

If your CD4 count is below 200 your doctor will recommend starting HIV treatment immediately. You have a risk of developing serious – and potentially life-threatening – illnesses. You may also need to take antibiotics (a treatment called prophylaxis) to prevent you developing opportunistic infections. Once your CD4 count has increased to above 200, you stop taking the prophylaxis. If you are already ill with an infection, you usually will start treatment for this before you start HIV treatment.

How effective is HIV treatment in people with low CD4 counts?

HIV treatment is highly effective. Many people’s CD4 count will start to climb after starting treatment. Long-term HIV therapy can result in your CD4 count returning to the normal level for your age. Once your CD4 count improves, with continued treatment and care, your life expectancy is very good.

Other factors, such as age, viral load, genetic make-up, lifestyle and quality of health care will also affect your future health and life expectancy.

Glossary

CD4 cell count

A test that measures the number of CD4 cells in the blood, thus reflecting the state of the immune system. The CD4 cell count of a person who does not have HIV can be anything between 500 and 1500. When the CD4 count of an adult falls below 200, there is a high risk of opportunistic infections and serious illnesses.

immune system

The body’s mechanisms for fighting infections and eradicating dysfunctional cells.

tuberculosis (TB)

A disease caused by the bacterium Mycobacterium tuberculosis. There are two forms of TB: latent TB infection and TB disease (active TB). In people with HIV, TB is considered an AIDS-defining condition.

effectiveness

How well something works (in real life conditions). See also ‘efficacy’.

viral load

Measurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. The VL is an important indicator of HIV progression and of how well treatment is working.

Some people’s CD4 cell counts do not increase, or rise very slowly, even though their viral load is ‘undetectable’. This can mean people are at greater risk of becoming ill and of dying of HIV-related illnesses. They may also be at greater risk of developing heart disease and cancers.

If this is the case, it is very important that you receive careful health monitoring so that any developing health problems can be detected and treated early.

Some research has suggested that the risk of developing health problems is linked to your lowest-ever (or ‘nadir’) CD4 count, even in people whose immune system has recovered well. However, other research has questioned this link.

Co-infection with TB and IRIS

The decision when to start HIV treatment may be more complicated if you have tuberculosis (TB). There are potential interactions between anti-HIV drugs and a key TB treatment. Some doctors recommend delaying treatment with anti-HIV drugs until after two or three months of TB treatment. However, this will depend on many factors, including your CD4 cell count. If your CD4 cell count is below 100, your doctor will recommend you start HIV treatment as soon as is practicable – ideally within two weeks of starting TB treatment.

A risk after starting HIV treatment is that you could develop a condition called immune reconstitution inflammatory syndrome (IRIS). This is where someone, soon after starting HIV treatment, seems to have worsening symptoms of another infection or disease, such as TB. In fact, the illness is thought to be caused by an improvement in the immune system’s ability to respond to infection. Your doctor will make a decision about how best to treat IRIS, but it is likely you will stay on HIV treatment unless you become seriously ill.

Having a diagnosis of AIDS

Acquired immune deficiency syndrome (AIDS) is the name used to describe a range of illnesses (chiefly infections and cancers) which can develop when someone’s immune system has been damaged by HIV.

In the UK, someone will be given an AIDS diagnosis if they develop an AIDS-related illness. Not all AIDS-defining conditions have the same outlook.

Being diagnosed with AIDS does not mean that your health will continue to deteriorate. Many people diagnosed with AIDS have become healthy again, with good treatment and care.

What can you do to look after yourself?

The most important thing is to start HIV treatment, and to take it exactly the way you are advised to (this is often called adherence).

“Once your CD4 count improves, with continued treatment and care, your life expectancy is very good.”

Attend your HIV clinic for regular check-ups. These monitor how your treatment is working, with regular screening for other health problems. Having a good relationship with your healthcare team is important, so that you feel able to be honest about your health, lifestyle, adherence and any other issues, to help you receive the best possible care and support.

Register with a GP (family doctor) for non-HIV-related health problems. GPs can give you an annual flu vaccination (recommended for people with a weakened immune system), and provide advice on lifestyle factors that help keep you well, including healthy eating, exercise and giving up smoking.

While your CD4 count is low (under 200), ensure your drinking water is free from infection and take extra care in preparing and storing food to avoid food poisoning. Be careful to avoid infections if you are handling animals or gardening. Your healthcare team can talk to you about any risks and give you advice.

Sexual health

Taking care of your sexual health to protect yourself and any partner(s) is important. Condoms are a very effective method of preventing HIV transmission. Being on effective HIV treatment (so that your viral load is ‘undetectable’) means that you are much less likely to pass on HIV.

Mother-to-child transmission

If you are diagnosed with HIV while you are pregnant, it is extremely important you receive the right HIV treatment and care as soon as possible. Even if you are diagnosed late in pregnancy, this can prevent your baby from being infected.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *