Transcript Session 2: Nutrition Complications with HIV and AIDS - I-TECH

Session 2:
Nutrition Complications with HIV
and AIDS
Nutrition Management with HIV and AIDS:
Practical Tools for Health Workers
Objectives
• Define nutrition complications related to
HIV and AIDS
• Identify ways to manage nutrition
complications
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 2
Malnutrition Defined
• Malnutrition is when:
• A person does not eat enough food
• A person eats too much of one food group
and not enough of other food groups
containing protein, vitamins and minerals
• Malnutrition decreases quality of life and
ability to work
• Serious problem for people with HIV and
AIDS
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 3
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
Impaired immune
system
HIV
Poor ability to fight HIV
and other infections,
Increased oxidative stress
Increased vulnerability to
infections
e.g. Enteric infections, flu, TB
hence Increased HIV replication,
Hastened disease progression
Increased morbidity
Source: RCQHC/FANTA/LINKAGES. 2003 http://www.fantaproject.org/focus/preservice.shtml
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Weight Loss and HIV
• >10% weight loss shown to decrease
survival in HIV-positive patients (Wheeler
1998; Tang 2002)
• Weight loss associated with onset of
opportunistic infections (Wheeler 1998)
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Micronutrients (MN) and HIV
• Since beginning of HIV epidemic, MN deficiencies found
in HIV+ individuals
• Selenium, B12, C lower in HIV+ compared to HIV- healthy
controls
• Vitamin A levels lowest in pregnant women in developing
countries, but also in injection drug users
• Iron deficiency and overload have deleterious effects on immune
system
• Serum MN levels vary depending on stage of disease
and acute phase response therefore difficult to research
• MN supplementation shown in many studies to have
effect on morbidity and mortality in adults and children
on HAART or not
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Causes of Malnutrition
• Unhealthy eating habits (not choosing
nutritious foods and drinks), alcohol or
cigarette use
• HIV infection and co-infections
• Side effects of medications (weight loss,
diarrhoea, etc)
• Food insecurity, poverty
• Pregnancy
• Metabolic and endocrine changes
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 7
Specific Complications with HIV/AIDS
• Wasting syndrome
• Loss of appetite
• Nausea and/or
vomiting
• Fevers
• Diarrhoea or
malabsorption
• Tuberculosis
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
• Sores of the mouth or
throat
• Changes in taste
• Metabolic or
endocrine changes
• Micronutrient
deficiencies
Slide 8
Loss of Weight
Extremely dangerous
due to:
• Loss of immune function
• Increased risk of infection
• Shortened survival
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Key interventions:
• Prevention of weight
loss and
malnutrition
• Identify and treat
weight loss early
• Nutrition
management
• Weight, height and
body mass index
(BMI)
Slide 9
Loss of Weight:
Nutrition Management
• Address other symptoms or infections
• Evaluate causes, check for parasites
• Increase energy intake from food (add
high-energy meals/snacks)
• Address food availability issues
• Obtain height and weight at each visit
• When available, add multivitamin
supplements and/or high calorie protein
drinks
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 10
Wasting Syndrome
• Loss of greater than 10% of body weight,
unintentionally, with persistent or chronic
diarrhoea or unexplained, persistent fevers
for greater than 1 month
• Loss of >10% body weight (measured and
unintentional) over preceding 12 months
OR loss of 5% body weight in 6 months
sustained for 1 year
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Nausea and/or Vomiting
• Nausea: a stomach distress with distaste for
food and an urge to vomit
• Caused by medications, HIV, and other
infections
• Leads to poor food intake and weight loss
• Management:
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•
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Small meals, frequently
Dry foods
Avoid lying down after meal
Drink liquids between or after meal
Assure adherence to medications and, if possible,
take medications with food
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Fever
• A rise of body temperature above the
normal (36.7 degrees Celsius)
• High body temperature leads to high
energy use and weight loss
• Need increased energy intake from food
• Need increased fluid intake
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 13
Persistent Diarrhoea
• Diarrhoea: 3 or more loose or watery stools in a
24 hour period
• Persistent diarrhoea: diarrhoea that lasts for 2
weeks or more
• Caused by malabsorption, HIV, other infections,
and/or medications
• Leads to weight loss, dehydration, malnutrition
• Chronic diarrhoea can lead to malabsorption of
medications, leading to suboptimal levels of ART
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Nutrition Management of
Persistent Diarrhoea
• Treat dehydration (ORS, home solution)
• Easy-to-digest foods (porridge, rice, bread,
bananas, cooked apples, yoghurt/omaere)
• Small meals, frequently
• Avoid rough foods like some raw greens or
cabbage; instead cook these until soft and
easier to digest
• Avoid fatty foods (with fat malabsorption)
• Avoid high sugar foods
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 15
Loss of Appetite or Anorexia
• Caused by medications or illness
• Management:
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•
•
•
Small, high energy meals, frequently
Eat most when feeling hungry
Add locally available herbs or spices to meals
Exercise
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 16
Changes in Taste
• The loss or change in taste sensation causing
less desire to eat food
• Mouth often tastes metallic
• Caused by medications or mouth sores
• Management
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Maintain oral hygiene
Treat sores
Add herbs/seasonings to foods
If meat is not appealing, encourage other protein
foods like chicken, eggs, fish, beans or milk
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 17
Thrush or Sores in the Mouth
• A fungal infection causing painful sores in mouth
and throat affecting food intake
• Caused by medications or infections (more
persistent with low CD4 level)
• Management:
• Maintain oral hygiene: rinse mouth with warm water
plus salt or bicarbonate of soda
• Choose soft, mashed foods
• Drink liquids with straw
• Avoid high acid foods (ex: oranges, tomatoes)
• Avoid sugary foods (sugar promotes yeast growth)
• Assure adherence to medications
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 18
Iron Deficiency and Anaemia
• Anaemia has multiple causes
• Chronic illness, low serum Fe
• Nutrient deficiency (Fe, folate, B12)
• Hookworm, malaria, malignancy, OI,
and AZT use
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 19
Iron Deficiency and Anaemia (2)
• Iron supplements, especially if
anaemia is not iron deficiency related,
may be more harmful
• Recommend: multivitamin/mineral
(MVM) supplement and encourage
iron-rich foods
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Vitamin A Deficiency
and Supplementation
• Vitamin A Deficiency
• Most significant in children and post-partum women
• Indications for supplementation:
• Preventative vitamin A supplement immediately after
birth to all women and to all children 0-5 years old
• Treatment doses for diarrhoea, measles, pneumonia
in children
• Unclear if beneficial in addition to MVM for PLWHA;
best taken in MVM
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Zinc and Selenium
• Zinc and Selenium
• Some research indicates zinc deficiency in
PLWHA on HAART
• Selenium supplementation shown to improve
HAART response
• Ensure adequate levels in MVM supplement
• Zinc supplements (20mg) beneficial in
diarrhoea treatment (but not yet available in
state sector in Namibia)
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 22
Calcium and Bone Problems
• HIV and HAART shown to promote bone loss,
still under research
• Could lead to early osteoporosis
• Encourage calcium and vitamin D-rich foods:
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Milk, cheese, yoghurt
Spinach
Dried fish
Beans, lentils, peas
• Prescribe multivitamin/mineral supplement
• Avoid alcohol and excessive caffeine use
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Specific Nutrient Considerations
with TB
• Increased calorie intake (10-30% more)
• Increase foods rich in protein, vitamins and
minerals to rebuild and heal lung tissues
• Increase vitamin B6-rich foods if having skin
irritations or numbness
• Beans, brown bread, bananas, potatoes, oilseeds,
unsifted maize, green leafy vegetables
• Increase fermented foods and drinks to increase
“good” bacteria, often destroyed by TB
medications
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Nutrition During Illness
• All people need food at all times – if they
are sick or not
• For terminally ill clients, provide extra
comfort and hydration
• Assist patients in hospital with eating
• For out-patients, ask about home based
care or other support in the home or
community
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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“Nutrition Management”
• What does this mean?
• “Management” involves counselling,
education and giving nutrition advice
• Food is not a cure for HIV, but it can help a
person feel better and live longer
• Integrate with other health interventions like
medications, immunisations, etc.
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Nutrition Counselling
• Listen to the client
• Each client is different
• Allow client to make decision, but provide
guidance
• Consider household/food situation
• Refer for community assistance
• Follow-up
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Case Study
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
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Key Points
1. Malnutrition and weight loss are serious for
people living with HIV and AIDS, impacting the
rate of morbidity and mortality
2. Proper nutrition can help manage
complications
3. Make sure clients are still eating, even when
they are sick
4. Help clients address difficulties early to prevent
malnutrition
Session 2: Nutrition Complications with HIV and AIDS
Nutrition Management with HIV and AIDS Training
Slide 29