[pronut-hiv] "which is best approach to supplement moderately malnourished HIV-infected children?"

["Billing, Nathan" <Nathan.Billing@chelwest.nhs.uk>]

George, 

 There are a number of companies that make nutritional support products
that we use here in the U.K. and as health professionals we do not
necessarily endorse the products, in fact against our code of conduct to
endorse one product over another as state registered dieticians. 

However we do have the range of products available to prescribe
controlled within the NHS by the Advisory Committee on Borderline
Substances.
http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Pharmaceuticals/ACBS.
htm. Maybe there needs to be similar consensus amongst the nutritional
community at large as to which products would be preferred to be used
for malnutrition programmes. 

Also although some companies have done significant damage in developing
countries through aggressive marketing of their products I do not feel
that this is the forum to debate why companies listed on the stock
exchange main ethical responsibility are to it's share holders rather
than the greater community they work in.  If they did not make profits
they would be out of business and we would not have their products to
use. 

 Anyway back to the question at hand "which is best approach to
supplement moderately malnourished HIV-infected children?"

 There are a number of products other than e-pap or plumpy Nut that are
available that I have had the experience of using while working in South
Africa that have not been mentioned in this forum.

http://www.diva.co.za/product_info.php?product=Nutri-mil

The complete range

http://www.diva.co.za/product_category.php?cat=Supplemental
 
I guess the major draw back of these supplements is the fact that they
need to be reconstituted with water, which may not safe and one of the
reasons people are going for plumpy nut (which given its high fat and
sugar content probably has a low water activity level and is less prone
to bacterial contamination).

Bacterial contamination is a huge problem when it comes to
reconstituting feed was demonstrated earlier this year in a study by
Marino et al S Afr Med J. 2007 Jul;97(7):534-7.
<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T
ermToSearch=17805457&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pub
med_ResultsPanel.Pubmed_RVDocSum>  .  They concluded 'Ready to use
infant feeds are sterile and are recommended for use in all hospitalised
infants. The results of this study indicate that even when milk is
prepared in a controlled environment there is significant bacterial
contamination of paediatric infant feeds post production.'

I look forward to hearing of other potential solutions to this problem
and to further lively debate.

 Nathan Billing 

Specialist HIV Dietitian 

Chelsea and Westminster NHS Foundation Trust 

Direct Line Tel: 020 8746 8176 or 

Tel: 020 8846 1000  Bleep 4150 


----- George Carter wrote:
 

Ross Labs is owned by Abbott which manufactures the Ensure.

 

Then there is always Nestle, another DEAR friend of the African  

people. See, e.g., http://www.ibfan.org/english/news/press/ 

press15may01.html

 

They make Nutren which is little better than the Ensure sugar/water/ 

bad fat fiasco. And claim a doctor is needed to figure out who to  

give this garbage to.

 

and another here:

http://www.babymilkaction.org/CEM/compapr00.html

 

and yet another--

http://www.westonaprice.org/children/tricks.html

 

Quote: The baby food industry has used and needs health professionals  

to endorse, distribute and sell its products. According to an Abbott  

Labs publication, "As the voice of Abbott, Abbott Topics can be a  

positive force molding the physicians' opinion of Abbott. In effect  

we are striving to make the physician a low-pressure salesman of  

Abbott."

 

These companies really do not seem to give a damn who or how many  

they harm or kill as long as profits, profits, profits are increasing  

exponentially to keep the parasites on Wall Street happy. I'm  

grateful to the moderators for having galvanized me into examining  

these practices more carefully. I think it behooves everyone on this  

list to be extremely doubtful of claims made by second rate salesmen  

from the industry that has sought so assiduously to cause enormous  

suffering and death by blocking access to generic HIV and other  

medications. (A happy note: Pharmaceutical company Matrix  

Laboratories said it has received tentative approval from the US Food  

and Drug Administration (FDA) for Tenofovir Disoproxil Fumarate  

tablets, used for the treatment of HIV infection.)

 

Realizing that the US and European "private sector" has nothing to  

offer Africa and developing nations but more rape, let us return to  

the discussion with renewed vigor on local, sustainable and healthful  

programs of nutrition for children and mothers with and without HIV  

infection. I think the data from this past year's Retrovirus  

conference further underscored the safety and practicality of  

exclusive breastfeeding for HIV+ mothers, where and whenever that is  

feasible.

 

George M. Carter