At the population level, Boneya et al. present the multi-facility cross-sectional study "Fruits and vegetables dietary intake and its estimated consumption among adults receiving antiretroviral therapy in health facilities in Northcentral Ethiopia." The study documents markedly low fruit and vegetable intake among adults receiving ART, falling well below recommended levels despite residence in agriculturally productive areas. These findings reveal critical gaps between food availability, dietary practices, and access to comprehensive nutritional education and counseling, emphasizing the need for context-specific dietary guidance integrated into routine HIV care.Extending beyond individual dietary behavior, George et al. explore structural and policy influences in the qualitative study "Understanding perspectives of HIV/AIDS affected households on food and nutrition interventions and social protection programmes in Zimbabwe." Drawing on lived experiences of HIV-affected households, the study illustrates how food insecurity, livelihood instability, and social protection mechanisms shape nutritional resilience. Importantly, the authors highlight the need for policy-driven program designs that explicitly define PLHIV as a vulnerable group and embed capacity building and resilience strengthening as core components to ensure sustainability.Addressing pediatric vulnerability in humanitarian contexts, Abraham et al. report findings from an institution-based cross-sectional study titled "Nearly half of HIV-positive children attending public health facilities are suffering from chronic under-nutrition in conflict-affected zones of Southern Ethiopia." The study reveals a substantial burden of chronic undernutrition among children receiving ART, underscoring the compounded effects of conflict exposure, recurrent infections particularly diarrhea limited dietary diversity, and household-level constraints. These findings emphasize the urgent need for early detection, continuous nutritional monitoring, and implementation of nutrition-sensitive programs in conflict-affected settings, with particular attention to larger households consuming limited food groups. Across the manuscripts, several interconnected biological pathways emerge as central to nutritional support in HIV care. These include gut microbiota alterations associated with HIV infection and long-term ART exposure, persistent chronic inflammation despite viral suppression, immune function sensitive to nutritional status, and metabolic stability influenced by prolonged ART use. Neurocognitive health further emerges as a critical domain through which nutrition may shape functional outcomes and overall quality of life.While these studies provide valuable insights, they also highlight important gaps. Dietary patterns characterized by anti-inflammatory and antioxidant properties remain underrepresented in HIVspecific trials. Targeted nutraceuticals including DHA, omega-3 fatty acids, spirulina, and probiotics show promise as adjuncts to ART; however, larger and more diverse trials are required to clarify their clinical relevance across populations and settings.Equally important is the delivery of nutrition through structured medical nutrition therapy (MNT) models that incorporate individualized assessment, counseling, and longitudinal follow-up. Lifestyle-related factors such as physical activity, sleep quality, and stress management further complement nutritional strategies and align with holistic models of chronic HIV care.These conceptual relationships are synthesized in Figure 1, which integrates the biological domains addressed by the included manuscripts (inner ring) with nutritional and lifestyle strategies representing both current applications and future priorities (outer ring). At the center of this framework are people living with HIV, with ART as the foundation of care. Nutritional strategies function as adjuncts to enhance long-term health and must be supported by equitable food systems, social protection mechanisms, and robust health infrastructure.Together, the four manuscripts included in this Research Topic provide a coherent and forwardlooking perspective on nutritional support in HIV. By integrating biological, clinical, and structural insights, this collection advances current understanding while identifying priorities for research, clinical practice, and policy development. Moving beyond viral suppression alone to address persistent nutritional challenges is essential for strengthening immune health, resilience, and long-term quality of life among people living with HIV.
Kaneez Fatima Jawwad (Thu,) studied this question.