1. M ALNUTRITION

2. M ALNUTRITION AMONG IDU S : B ASIC FACTS Drug users are at increased risk of malnutrition regardless of whether or not they are infected with HIV Specific drugs may alter appetite, interfere with gastrointestinal absorption, and/or have proinflammatory responses that can lead to disturbances in metabolic rate Behaviorally, drug dependence may affect access to food and food selection

3. M ALNUTRITION AMONG IDU S : B ASIC FACTS The HIV infected drug users at greater risk for malnutrition The risk of comorbid conditions, such as hepatitis C (HCV) and tuberculosis (TB), is increased among drug using populations and may further affect nutritional and metabolic status

4. M ALNUTRITION AMONG IDU S : B ASIC FACTS Malnutrition may impact the course of HIV- infection through a variety of mechanisms: compromising host immune function diminishing response to therapies promoting co-morbidities

5. N UTRITION AMONG IDU S Nutritional compromise has been a hallmark of untreated HIV infection Persons with HIV infection often have inadequate dietary intake of calories, protein, and micronutrients They have unintentional weight loss which is a strong predictor of mortality

6. N UTRITIONAL STATUS OF IDU S : I NDIA Poor nutritional status in both HIV-positive and HIV-negative drug users Nutritional status worse in HIV positive drug users 52% of HIV-positive drug users and 50% of HIV-negative drug users having BMI levels below 18.5 kg/m 2 HIV-positive IDUs had significantly lower levels of fat mass, fat- free mass, and percent body fat than the HIV-negative IDUs HIV-positive IDUs had lower cholesterol levels and higher triglycerides than HIV-negative IDUs Tang et al, 2011

7. N UTRITIONAL STATUS OF IDU S : I NDIA Conditions which most certainly place HIV positive IDUs at higher risk of continued malnutrition: self-reported TB diarrhea laboratory-confirmed Hepatitis C infection among the HIV-positive IDUs Tang et al, 2011

8. S IGNIFICANCE OF IMPROVING NUTRITION AMONG HIV POSITIVE IDU S Emerging evidence suggests that poor nutritional status at the start of ARV treatment is predictive of mortality It may be important to improve nutritional status in the HIV-positive population prior to initiation of ARV treatment in order for patients to reap the full benefits of therapy

9. A NAEMIA

10. A NAEMIA IN DRUG USERS  Anaemia is highly prevalent among injecting drug users, both HIV infected and HIV uninfected  Anaemia may be contributed significantly by nutritional disorders among IDUs  Anaemia is highly correlated with frequency of injection and it is suggested that cessation of injection use may improve anaemia  Anaemia contributes to increased morbidity as well as mortality

11. A NAEMIA IN HIV INFECTED DRUG USERS Anemia is a common clinical finding in HIV-infected patients and is associated with: advanced disease lower quality of life higher mortality Factors contributing to the development of anemia nutritional deficiencies opportunistic infections AIDS-related malignancies drug treatment direct effect of HIV on the bone marrow

12. A NAEMIA IN HIV INFECTED DRUG USERS Zidovudine, an ARV can contribute to anaemia Iron deficiency Inflammation-induced iron maldistribution of iron HCV may possibly contribute to redistribution of iron

13. ART AND A NAEMIA ART can improve anaemia in HIV infected drug users: Reduction of opportunistic infections Reduction of associated anemia of chronic disease Reduction of gut abnormalities Improvement in micronutrient status