The main tangible output of the proposed study is an authoritative ASSAf Report published in the public domain but presented in an appropriate way (with contacts and briefing sessions prior to the public release of the report), to the Ministries/Departments of Science and Technology and of Health, the National Health Research Committee, the Medical Research Council and the various Provincial health departments; the main conclusions and recommendations are summarised in a readable and useful form. The document is one that can also be made available to teaching and training institutions to
influence the content and approach of their programmes and to the media in order to reach the broad mass of the public to help in preventive and promotive health.
The ASSAf report should influence public policy in the area of prevention, support and therapy of the pandemic infections now current, such as those with M.tb. and HIV, to achieve the anticipated benefits through provision of clear guidelines inter alia for:
the conduct of trials to assess the efficacy of nutritional interventions in HIV- and/or i.
M.tb.-infected individuals;
the use of general and specific nutritional interventions in preventing, controlling and ii.
ameliorating the effects of infections on their hosts;
cost-effective planning and resourcing of appropriate support measures for infected iii.
individuals and communities in meeting their nutritional requirements;
programmes of public health education, and partnerships with industry in employee iv.
support; and
the production/processing of foods and nutritional supplements.
v.
The report is written to maximise its impact of the resolution of controversy in this area, of improved health service planning and purposeful resourcing, and the general promotion of national cohesion in addressing the concurrent pandemic infections.
It aims to be decisive in achieving a much-needed turnaround of a critical national success factor, the health of our youth and of our economically active people, and the preservation of families as the social core of the nation.
Background
Background
Conceptual overview
Animals, plants and micro-organisms have evolved through biological history to create the enormous biodiversity of the planet today. Because they inhabit the available spaces together, much of what has happened along the way has been co-evolution, characterized by beneficial inter-dependence and reciprocal competition.
Few things illustrate this better than the relationship between humans and their by now ancient enemy, the bacterium that causes tuberculosis. Humans, as large, unspecialized and highly adaptable mammals with big brains and intricate social systems, have spread to almost every available niche and habitat on the globe;
Mycobacterium tuberculosis, a tiny, invisible, but very tough enemy, has achieved an almost identical distribution, living in as many as one third of all humans and spreading through frequent flare-ups, highly injurious to their host, constituting the “white death”
of our recorded history1.
HIV, by contrast, jumped within the last century from its long-term host, populations of particular great apes, to vastly numerous human populations, and now lives in some 50 million people in most parts of the globe. It spreads relentlessly during a slowly progressive disease process. Even this short period of interaction between very big humans and very tiny retroviruses is full of co-evolutionary phenomena2.
Humans have highly evolved immune systems (many of the most striking differences between the genomes of mammals such as rodents and us involved proliferation of defense mechanisms against microorganisms). We have gone beyond our formidable biological weapons to acquire pharmaceuticals (often, ironically, “borrowed” from harmless micro-organisms) to give us decisively effective additional advantages and back-ups in our ceaseless fight against the harmful microbes. Thus highly effective drugs have been developed specifically to counter Mycobacterium tuberculosis and HIV, in the first case curatively through the use of multi-drug combinations, and in the second case suppressively, also through multi-drug combinations.
It is important to bear in mind that the pre-antibiotic phase of dealing with TB was characterized by intense concentration on strengthening the immune defenses
of infected subjects with diets, improved and altered environmental conditions and every other conceivably helpful measure. After the discovery of effective drugs, this aspect of TB therapy quickly became secondary and largely uncontroversial. (With the more recent emergence of multi-drug resistant and extensively drug-resistant TB strains especially, these older measures may again have to be looked at as potentially valuable supportive measures in our total arsenal).
Because HIV infection cannot be cured but only controlled, with drugs being applied at particular, serious stages of progressive disease (according to current guidelines, at least) the emphasis in the management of infected people during the phases prior to drug administration is still on general, non-pharmacological support, especially as for many reasons it is highly desirable to postpone the introduction of specific antiretroviral therapy for as long as possible.
This study has examined the role nutritional support can play, in individuals and populations, at this time and in this place, against these two pandemic microbial enemies of Homo sapiens, in the light of the above macro-considerations.