Transcript NUTRITIONAL ASPECTS OF HIV

NUTRITIONAL ASPECTS OF
HIV CARE
Nurses at the Forefront of HIV Care
18-19 March 2010
Protea Court Yard Hotel
Entry points for raising nutritional
issues in providing care and
support
Part of
voluntary
counseling
and testing
programme
During
Counseling for
people with clinical
AIDS
During post
testing
counseling
NURSE
self-help groups
and support
groups for
carers
When
coming for
treatment
for illnesses
During
nutrition
education
Home
visits as
part of
home care
Outline
Food, nutrition, food groups & B. Diet
 Why nutrition and HIV? R’ship
 Aspects of nutrition that matter in
HIV/AIDS situation
 Assessment of nutritional status
 Nutritional mgt of diet related HIV/AIDS
complications
 Infant feeding options in HIV situation

Nutrition, Food groups & Balanced
Diet
Vicious Cycle
of Malnutrition and HIV
Poor Nutrition
resulting in weight loss,
muscle wasting, weakness,
nutrient deficiencies
Increased Nutritional
needs,
Reduced food intake
and increased loss of
nutrients
HIV
Increased vulnerability to
infections e.g. Enteric
infections, flu, TB hence
Increased HIV replication,
Hastened disease progression
Increased morbidity
Source: Adapted from RCQHC and FANTA 2003
Impaired immune system
Poor ability to fight HIV
and other infections,
Increased oxidative stress
Effects of HIV/AIDS on Nutrition
•
Decrease in the amount of food consumed
•
Impaired nutrient absorption e.g. poor
absorption of fats and CHOs due to
infection of intestinal cells by HIV,
diarroheoa,O.Infections
•
Changes in metabolism - infection increase
nutrients requirements CHOs (10 – 15 %)s
and Protein (50%+),
Causes of Decreased
Food Consumption
•
Mouth and throat sores
•
Loss of appetite leading to fatigue, depression,
and changes in mental state
•
Side effects from medication
•
Abdominal pain
•
Household food insecurity and poverty
REASONS FOR GOOD
NUTRITION
Good nutrition cannot cure AIDS or
prevent HIV infection, but it
 maintains and improve the nutritional
status of a person with HIV/AIDS
 delays the progression from HIV to AIDSrelated diseases.
 maintains body weight and fitness.
 maintains and improve the performance
of the immune system
 reinforce the effect of the drugs taken.
ASSESSMENT OF NUTRITIONAL
STATUS IN HIV

Why Measure?

To identify and track body composition changes over
time and trends
 Changes in weight
 Changes in body cell mass and fat-free mass
 Serum nutrient levels, cholesterol, hemoglobin etc.

To use results to design appropriate interventions

To address client concerns about their health
What to Measure?




Anthropometry
Laboratory tests
Clinical assessments
Diet history and lifestyle
Anthropometric Measurements
in HIV/AIDS
To assess and monitor weight
 Weight and height
 Percentage of weight and/or body mass index
changes over time
To assess and monitor body composition
 Lean body mass
 Body cell mass
 Skinfold (triceps, biceps, mid-thigh)
 Circumferences (waist, mid-upper arm, hips
[buttocks], mid-thigh, breast size for women, neck
circumferencve (buffalo hump])
Laboratory Measurements
in HIV/AIDS
To assess and monitor nutrient levels
 Serum micronutrients (e.g. retinol, zinc)
 Haemoglobin (and ferritin)
To assess and monitor body composition
 Fasting blood sugar,
 Lipid profiles (e.g., cholesterol and
triglycerides)
 Serum insulin
Clinical Assessments in HIV/AIDS
Symptoms and illnesses associated
with HIV/AIDS
 Diarrhea and vomiting
 Fever (temperature)
 Mouth and throat sores
 Oral thrush
 Muscle wasting
 Fatigue and lethargy
 Skin rashes
 Edema
Diet History in HIV/AIDS
24-hour food consumption or food
frequency recalls can be used (in the
absence of acute food stress) to assess
 Types and amounts of food eaten (including food
access and utilization and food handling)
 Use of supplements and medications
 Factors affecting food intake (appetite, eating
patterns, medication side effects, lifestyle, taboos,
hygiene, psychological factors, stigma, economic
factors)
Stages of HIV Disease and Nutrition
Specific nutrition recommendations vary
according to underlying nutritional
status and HIV disease progression
 Early stage: No symptoms, stable weight
 Middle stage: Weight loss, opportunistic
infections associated effects
 Late stage: Symptomatic AIDS
Nutrition Care and Support Priorities
by Stage of Disease
Asymptomatic: Counsel to stay healthy
Emphasize on importance of balanced diet and increased
nutrient demand
 Encourage building stores of essential nutrients and
maintaining weight and lean body mass
 Ensure understanding of food and water safety
 Encourage physical activity
Middle stage – Counsel to minimize consequences
 Counsel to maintain dietary intake during acute illness
 Advise increased nutrient intake to recover and gain weight
 Encourage continued physical activity
Late stage: Provide comfort
 Advise on treating opportunistic infections
 Counsel to modify diet according to symptoms
 Encourage eating and physical activity
Nutrition Actions for HIV-Infected People
To prevent weight loss
 Promote adequate energy and protein intake
 Individualize meal plan and modify to match
medication regime or health changes
 Advise changing lifestyles that negatively affect
energy and nutrient intake
To improve body composition
 Promote regular exercise to preserve muscle mass
 Promote steroids
To improve immunity and prevent infections
 Promote increased vitamin and mineral intake
 Promote food safety
 Promote use of ARVs to reduce viral load
Promote Food Safety
to Prevent Food-Borne Illness
Educate clients to avoid products that
1.
Contain raw or undercooked meat
2.
Are displayed unsafely (e.g., mixing raw and
cooked foods or meats with fruits and
vegetables)
3.
Are sold in unsanitary conditions or by workers
with poor personal hygiene or food handling
practices
Educate on Nutrition-Related Side Effects
of ARVs
Lipodystrophy (fat maldistribution)
MGT= exercises
Hyperglycemia/insulin resistance
MGT= Antioxidants (e.g., vitamin C and
selenium) to support glutathione, which is
crucial in insulin action
Hyperlipidemia
MGT=Decreased fat intake, Exercise,
Lifestyle changes (e.g., quitting smoking
INFANT FEEDING IN THE
CONTEXT OF HIV

“When replacement feeding is acceptable, feasible,
affordable, sustainable and safe, avoidance of all
breastfeeding by HIV-infected mothers is
recommended. Otherwise, exclusive breastfeeding is
recommended during the first months of life”
WHO,2001
Options
Exclusive breast feeding for short period
- Period for breastfeeding should be decided
by the mother and father
 Replacement feeding

1.Access to affordable breastmilk substitutes
2.Access to facilities for hygienic preparation
Counselors: Identify food security constraints
and support options to address them
THANK YOU FOR LISTENING !