Nutritional supplementation and HIV/AIDS in Chad

The nutritional status of people living with HIV/AIDS (PLHA) in low and middle income countries (LMIC) remains a major determinant of mortality, a lower response to the antiretroviral treatment (ART) and a higher dropout rate from ART. Poor nutritional status is common among PLHA in LMIC. It results in wasting and micronutrient deficiencies which increase the risk of morbidity in a weakened immune response. Adults infected with HIV have their energy requirements increased by 10%; and this increase may reach 20-30% when they are symptomatic (WHO, 2003). Poor nutritional status of PLHA is essentially a result of 1) poor dietary practices, 2) nutrient malabsorption, and 3) recurrent infections. Nutritional care of PLHA when combined with ART improves food security of the already vulnerable population and might enhance the response to treatment by improving the nutritional status of PLHA. In Chad, the National Council for the fight against AIDS estimated that in 2014-2015 there were 206,467 PLHA (1.6% of the population). Among these people, slightly less than half needed an ART. Since 2007, the medical care of PLHA was guaranteed by the Ministry of Health who provided the ART gratis in the whole country. However the lack of nutritional care of PLHA remains a serious problem that limits the progress in improving the quality of life among PLHA. Spirulina (Spirulina platensis) is a blue-green algae that is promoted as a dietary supplement because it is rich source of high quality macro- and micronutrients. There is a limited number of studies available assessing the effectiveness of spirulina supplementation in the nutritional care of PLHA.The study aims to assess -among PLHA receiving ART- the effectiveness of nutritional care of PLHA, i.e. supplementation with fortified or unfortified millet flour with spirulina, on their nutritional status and response to ART compared to PLHA who just started ART but receive standard care without supplementations.