Transcript Ch 41 - HIV AIDS

Chapter 41
Medical Nutrition
Therapy for
Human
Immunodeficiency
Virus (HIV) Disease
Human Immunodeficiency Virus

HIV is a virus that targets the body’s
immune system and inhibits a person’s
body from producing adequate immune
defenses.

This virus can develop into AIDS
over time.
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Acquired Immunodeficiency
Syndrome

AIDS is the final stage of HIV.

AIDS is a disease that prevents the
body’s ability to fight off infection
and illness.
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HIV and AIDS

Opportunistic infections and rare skin
cancer, Kaposi’s sarcoma, depressed cellular
immunity are common.

HIV virus destroys the T helper cells or T4.

Acute phase of infection 2 wks; 8 wks later,
test positive for HIV infection
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HIV Infection

30% to 60% develop an acute syndrome
with malaise, fever, pharyngitis,
lymphadenopathy, headache, myalgia,
and sometimes a rash
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Risk Factors for Contracting HIV

HIV can be transmitted through four different
types of fluids that can enter the bloodstream
1. Blood
2. Semen
3. Vaginal fluids
4. Breast milk (mother)

Fluids such as saliva, sweat, tears, and urine do
not transmit the virus, but HIV antibodies may
be present in these fluids.
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People at Risk for HIV

Heterosexuals with more than one sex
partner

Hemophiliacs—inability to clot blood

These people have many blood transfusions.

Homosexual or bisexual males

Intravenous drug users

Infants with HIV-positive mothers
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Acquired Immunodeficiency
Syndrome

Diagnosed when a person has HIV
infection and CD4 cell count below 200
or less than 14%

Dementia, wasting syndrome,
malignancies such as Kaposi’s sarcoma,
or one of more than 26 opportunistic
infections
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Diagnosis of HIV and AIDS

Tests
– ELISA an immunosorbent assay—
Check for antibodies of HIV
(2 weeks’ postexposure)
– Western blot—more accurate but
not 100%
– Polymerase chain reaction (PCR)—
detects viral nucleic acids in virus;
most sensitive
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Symptoms of HIV and AIDS

Early: fever
Weight loss
Diarrhea
Flulike

Later: opportunistic infections
Malignancies
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Common Problems in HIV/AIDS

Fungus infections: thrush

Meningitis

Pneumonia

Protozoal infections—infection in large
and small bowels

Viral infections—herpes; shingles
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Lipodystrophy

Reported among people taking any of the
licensed protease inhibitors

Disturbed fat metabolism

Loss of thin layer of fat; veins protrude

Wasting of face and limbs

Accumulated fat in abdomen under skin
and inside body cavity or between
shoulder blades
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HIV Medical Management
The goals of medical management of HIV are to:

Prolong life and improve the quality of life for
the long term

Suppress the virus to as low a level as possible
for as long as possible

Optimize and extend the usefulness of currently
available therapies

Minimize drug toxicity and manage
side effects
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Nutritional Assessment

Nutritional assessment: necessary for detecting
and reducing HIV and AIDS malnutrition

After diagnosis of HIV, nutritional screening
should be performed immediately while still
clinically asymptomatic.

Through biochemical measurements, serum levels
of vitamins and minerals can be obtained to
identify micronutrient deficiencies.

Three major components of nutritional assessment
include medical diet history, physical assessment,
and laboratory studies.
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Nutritional Assessment—cont’d

Serum proteins can be measured to assess
visceral protein status.

Measuring cellular levels of nutrients
such as liver store of vitamin A or
leukocyte levels of vitamin C may be a
valid method of assessing body stores.

Hypoalbulminemia is associated with
reduced survival in people with AIDS.
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Nutritional Assessment—cont’d

Percent UBW more important than
percent IBW—patients don’t lose fat
as much as lean

TLC and delayed cutaneous
hypersensitivity not helpful
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HIV Assessment

Baseline status at diagnosis

Follow and reassess as complications
develop

Consider mental status

Misinformation

Knowledge of food sanitation and
good nutrition
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General Goals of Nutrition
Intervention in HIV Disease

Preserve optimal somatic and visceral
protein status

Prevent nutrient deficiencies or excesses
known to compromise immune function

Minimize nutrition-related complications
that interfere with either intake or
absorption of nutrients

Support optimal therapeutic drug levels

Enhance the quality of life
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Nutritional Goals

A combination of nutrition support and
drug therapy allows people with HIV and
AIDS to live longer, better-quality lives.

Maintain good nutrition and exercise to
improve health and slow down HIV
infection.

Prevent weight loss.
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Medical Nutrition Therapy Requires
Six Distinct Components

Screening

Referral

Assessment

Intervention

Outcomes evaluation

Communications
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Management of Symptoms in
HIV/AIDS

Nausea and vomiting

Loss of appetite

Sore mouth and throat

Diarrhea

Poor absorption of nutrients

Abdominal cramping

Weight loss
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Eating Tips for Common Symptoms

Lack of appetite
—Eat favorite foods often.
—Eat snacks or a small meal every 2 to 3 hours.
—Go for a short walk or exercise to boost appetite.

Nausea and vomiting
—In the morning eat crackers, dry toast, or dry cereal.
—Avoid greasy, fried, or very sweet foods such as
french fries, pastries, and ice cream.
—Sip on flat sodas, weak ginger tea, or mint tea.
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Eating Tips for Common
Symptoms—cont’d

Sore mouth and throat
—Try soft smooth foods, like mashed potatoes,
applesauce, baby foods, and cream soups.
—Avoid foods that sting or irritate the mouth, like
orange or tomato juice, hot sauces, and salty foods.
—Eat cold foods, such as Popsicles or ice cream.

Diarrhea
—Eat foods like bananas, applesauce, rice, and gummy
candy.
—Cut back on fatty foods.
—Cut down on fiber in the diet.
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Suggested Diets for HIV/AIDS
Patients

Diets rich in fruits and vegetables that includes
iron, vitamin E, and riboflavin may delay the
development of full-blown AIDS.

There have been many alternative therapies that
include nutrition-based options such as
megadoses of nutrients, Dr. Berger’s Immune
Power Diet, and macrobiotic diet.

Most of these diets are low in fat and calcium
and high in fiber. They have not been proven
effective.
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Roles of the Dietitian

Guiding the patient with emotional support,
proper nutrition, and incorporating exercise into
the daily routine are some of the challenges
dietitians face.

Monitor body composition and hormone levels
to improve body composition.

Monitor blood lipid, sugar levels, diet, and
medications to prevent hyperlipidemias and
elevated blood sugars.
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Wasting Syndrome

Wasting syndrome is defined as the unexplained
weight loss of more than 10%, and is
accompanied by fever or diarrhea for 30 days.

It is considered a condition that is an indicator
for AIDS.

It is a multifactorial condition that can be
associated with variety of infectious, neoplastic,
metabolic, and nutritional abnormalities.
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Nutritional Calculations

Energy—HB for BEE
Add injury factors
x 1.3 maintenance or 1.5 weight gain

Protein
1 to 1.4 g/kg/day maintenance
1.5 to 2.0 g/kg/day repletion

Fat—adjust for malabsorption
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Nutritional Calculations—cont’d

Fluids and electrolytes
Consider symptoms and replace for fever,
diarrhea, night sweats, vomiting

Vitamins and minerals
Increased needs for ß-carotene, E, C, B12, B6,
folate
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Food Safety Suggestions

Wash hands with hot soapy water before
touching or eating foods.

Cook meat, poultry, fish, and eggs until they are
well done.

Wash fresh fruits and vegetables thoroughly.

Drink filtered water.

Wash dishes and cutting boards in hot soapy
water.

Use leftovers in refrigerator within 2 days.
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Strategies for Reducing the Risk
of Cryptosporidiosis
Data from Centers for Disease Control and Prevention. Cryptosporidiosis: a guide for persons with HIV/AIDS, Atlanta, 1995, CDC.
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Nutrition-Related Complementary
and Alternative Therapies
Herbs/botanicals
—Astragalus
—Cat’s claw
—Echinacea
—Garlic
—Ginseng
—St. John’s wort

Megadoses of
vitamins and minerals

Antiviral AL-721 and
homemade formulas

Dr. Berger’s Immune
Power Diet and
maximum immunity
diet

Homeostatic
macrobiotic diet

Medical marijuana

Yeast-free diet

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Drug Therapy

Antiretroviral drugs—they block the core
enzyme reverse transcriptase that is necessary
for viral replication and terminate DNA chain
formation

Examples:
—AZT (Retrovir)
—Videx
—Epivir
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Drug Therapy—cont’d

Protease inhibitors—prevent the formation of
mature infectious viruses (they work late in the
viral cycle and block the activity of the viral
protease)

Examples:
—Norvir
—Invirase
—Crixivan
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Drug Therapy for Involuntary
Weight Loss

Medicine used to promote weight gain after
involuntary weight loss as a result of surgery,
infections, or severe trauma.

Oxandrin—increases protein synthesis in the
skeletal muscle and improves intracellular
reutilization of amino acids. It works
synergistically with dietary protein.
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Nutritional Referral
Referral information should include the following:

Consent to release medical information

Current diagnosis and medical history

Referring health care provider’s nutrition
prescription or desired outcome

Clinical symptoms and feeding route

Weight history and body composition

Recent biochemical data
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Nutritional Referral—cont’d
Referral information should include the following:

Current medications (prescription and
nonprescription drugs, vitamins, minerals, and
other dietary supplements)

Use of complementary and alternative therapies

Functional status

Lifestyle, psychosocial status, and
activity/exercise routine, including substance
use pattern
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