Transcript PowerPoint Presentation - Lisa Sharp

HIV/AIDS
Presented by
Libby Sells
Lisa Sharp-Gomez
Overview
 Disease
 Etiology
 Diagnosis
 Treatment
 Patient
 Assessment
 Diagnosis
 Intervention
 Treatment
 Medical Nutrition Therapy
 Monitoring and Evaluation
 Prognosis
 Resources
Disease Description and Etiology
 Definition
 HIV is a retrovirus that targets the CD4 cells of the immune
system (the T-Helper cells) and turns them into viral factories for
HIV reproduction
 Transmission
 The HIV virus is transmitted from person to person via infected
body fluids. This includes sexual contact, infected needles,
blood transfusions and mother to child.
 AIDS is the advanced manifestation of HIV that has the
potential to make a person vulnerable to opportunistic
infections
Diagnosis of HIV and AIDS
 Diagnostic tests
 ELISA - Enzyme Linked Immunoabsorbant Assay
 Western Blot
 IFA- Indirect Immunoflorescent Antibody
 RIPA - Radio Immunoprecipitation
 PCR - Polymerase Chain Reaction
 Alternative diagnostic tools
 Urine and oral fluid tests
 Finger prick
CDC Clinical and Immune Cell Categoies
of HIV Infection
Categories
Sample Criteria
Primary HIV Infection
Acute retroviral syndrome, but no complicating opportunistic infection or immune
dysfunction
Clinical Stage 1
Primarily asymptomatic as above, possible persistent generalized lympadenopathy
Clinical Stage 2
Weight losses that are <10% of body weight, herpes zoster, minor mucocutaneous
manifestations, recurrent bacterial upper respiratory tract infections, fungal infections of
fingers, papular pruritic eruptions, or seborrhoeic dermatitis
Clinical Stage 3
Weight loss of >10% of body weight, persistent constitutional symptoms (fever, diarrhea),
oral candidiasis or hairy leukoplakia, acute necrotizing ulcerative gingivitis or necrotizing
ulcerative periodontitis, pulmonary tuberculosis, severe bacterial infections, unexplained
anemia, neutropenia and or thrombocytopenia for more than a month (confirmatory
testing is required for anemias)
Clinical Stage 4
HIV wasting syndrome (>10% weight loss with chronic diarrhea, weakness, fever),
opportunistic events as described in Clinical Category 3 as well as chronic herpes simplex
virus, recurrent severe or radiological bacterial pneumonia, pneumoncystitis pneumonia,
Kaposi’s sarcoma, CMV, cryptosporidiosis, isopsoriasis, any disseminated mycosis (eg.
Coccidiomycosis, histoplasmosis, penicilliosis) recurrent non-typhoidal salmonella
septicaemia and or lymphoma (cerebral or B cell non Hodgkin)
HIV and AIDS Treatment
 There is no cure. Treatment is by symptom management
only.
 Treatment includes anti-viral medications, prevention and
treatment of opportunistic infections (OI) and restoration of
nutritional status
 Treatment is multi dimensional involving physicians,
dietitians and psychologists
 A person’s geno- and phenotype can help determine the
appropriate therapy.
Anti Retro Viral Medications
 The goal is to lower the viral load (copies of the virus per ml of
blood)
 Medications interrupt the viral life cycle, thus decreasing the spread
from cell to cell within the body.
 HAART – Highly Active Anti Retroviral Therapy
 Includes 3 or more ARV medications
 Side Effects:
 Nausea, diarrhea, appetite loss, lipid alterations and glucose
intolerance.
 Lipodystrophy
Opportunistic Infections
 Examples: Pneumonia, Encephalitis, tuberculosis, Influenza,
HPV, Hepatitis A and B and Malaria
 Early detection is important
 Vaccines are useful in preventing some infections like HPV
and Hepatitis
AIDS Wasting Syndrome Treatment
 Defined as weight loss greater than 10% of body weight
combined with fever or diarrhea for more than 1 month.
 Or 7.5% weight loss in 6 months
 Megestrol Acetate and Dronabinol are used to increase
appetite and reduce nausea.
 Strength building exercise can be used to retain muscle mass
 May also be managed with Androgens and Growth Hormones
 This hormone therapy is also used to manage lipodystrophy
Alternative Supplements and Oral
Therapies
GINSENG
American ginseng is used for other infections including HIV/AIDS, infections of the
intestine (dysentery), and particular infections (Pseudomonas infections) that are
common in people with cystic fibrosis.
Some people use American ginseng to improve digestion and for loss of appetite, as well
as for vomiting, inflammation of the colon (colitis), and inflammation of the lining of the
stomach (gastritis).
MILK THISTLE
(SILYMARIN)
Silymarin exerts membrane-stabilizing and antioxidant activity, it promotes hepatocyte
regeneration; furthermore it reduces the inflammatory reaction, and inhibits the fibrogenesis
in the live
ECHINACEA
Anti-Cancer, immunostimulatory, may inhibit metabolism of drugs using the cytochrome P
450 enzyme pathway.
ST. JOHNS
WORT
Anti-depressant, anti anxiety, anti HIV, contraindicated with the use of medications processed
by the CYP3A4 and P glycoprotein Pathways, including protease inhibitors and NNRTI’s,
reduced effectiveness of oral contraceptives, antagonistic to antihypertensive medications
Patient Assessment and Etiology
 Etiology – Unknown
 Terry Long , 32 years old. African American male, HIV positive for 4
years, diagnosed with Stage 3 AIDS and oral thrush. Family history of
CAD and HTN, stopped smoking 5 years ago, consumes 2-3 drinks 3-4
x/week.
 Taking multivitamin, vitamin E, vitamin C, ginseng, milk thistle, Echinacea,
St. John’s wort, prescribed HAART regime with Atripla and Fluconazole IV
 Anthropometrics
 Weight – current 151, usual 165, % UBW 91.5 BMI 19.9 kg/m2
 TSF 7mm < 50 percentile
 BP 120/84
 12.5% body fat
Patient Assessment and Etiology
Patient Assessment and Etiology
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Clinical
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Diet
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White patchy exudate in throat
Dry, warm, flaky skin
Rhonchi in left lung
Hyperactive bowel sounds
Current - Liquid and soft foods due to mouth pain
Usual diet - 2000 kcal intake
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52% from carbohydrates
37% from fats
15% from protein
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540 non nutritive calories from alcohol
Current Diet – 860 calories
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70% from carbohydrates
25% from fat
5% from protein
Patient Diagnosis
 1) Unintentional weight loss (NC-3.2) related to HIV/Aids,
difficulty swallowing and inadequate caloric intake as
evidenced by BMI of 19.2, 91% UBW and recent weight loss.
 2) Difficulty swallowing (NC-1.1) related to oral thrush as
evidenced by patient’s complaints and 24 hour diet recall.
 Stage 3 AIDS with oral thrush.
Patient Intervention and Treatment
 Multidisciplinary approach to treatment
 Priorities: concern for diabetes, insulin resistance, hepatitis,
renal and pancreatic malfunctions, cardiovascular disease
and osteoporosis
Goals
 Prevention of food, drug and supplement interactions
 Restoration and maintenance of nutritional status
 Management of signs and symptoms
 Appetite loss
 Diarrhea
 Heartburn/reflux
 Nausea/vomiting
 Oral lesions
Medications/Supplements
Taken By Patient
Supplement
Proposed Use in HIV/AIDS
Potential Risks
Vitamin C
Improve antioxidant capacity, increases iron absorption from nonheme sources
Increases urinary losses of oxalate and
calcium
Vitamin E
May protect against toxicity and sice effects from AZT
(antiretroviral medications)
Can interfere with blood clotting, cause
nausea, diarrhea, muscle weakness fatigue
Ginseng
Anti-stress and anti-fatigue effects, may contain a protein with
anti-HIV activity
Morning diarrhea, insomnia, nervousness,
depression, confusion, skin rashes, high
blood pressure
Milk Thistle
May prevent liver damage caused by ARV medications
Upset stomach, diarrhea, bloating, gas
Echinacea
Anticancer; immuno-stimulatory; promotes CD4 cell activation
May inhibit metabolism of drugs sing the
cytochrome P450 enzyme pathway
Multivitamin
Slows disease progression, increases CD$ count, lowers viral load
values
None
Medication
Proposed Use
Interactions
Efavirenz
Controls HIV infection by decreasing the amount of HIV in the
blood and may decrease chance of developing AIDS and HIV
related illnesses like serious infections or cancer
May interact with products that contain
Kava or St. John’s Wort. Avoid alcohol and
take on an empty stomach
Tenofovir DF
Interferes with HIV replication in the body
High fat meals increase bioavailability.
Avoid alcohol as it can worsens side
effects
Emtricitabine
Inhibits the enzyme that copies HIV RNA into new viral DNA. Can
help lower the amount of HIV in the body and increase the
Avoid alcohol as it can worsen side effects
Physical Activity Recommendations
Exercise known to improve muscle volume and function
Regulates lipid and energy metabolism
For patients with HIV/AIDS may lessen the loss of muscle mass
in wasting conditions.
Recommendations should complement diet prescription
Exercise should include a combination of aerobic and resistance
training.
Medical Nutrition Therapy
 As infected cells in the gut increase, there is an increased risk
of malabsorption and malnutrition increase
 ARV’s can increase blood lipid levels and inflammation,
diabetes and hypertension can put patients at an increased
risk for cardiovascular diseases.
 HIV can affect all body systems causing a variety of
nutritional complications.
Nutrient Requirements
 Fluids: 1 ml/kcal = 3 L per day
 Calories: 2900 – 3300 actual calculated 2400 calories, but
increase 20-50% due to OI.
 Protein: 59 grams based on current body weight, or 145
grams based on 20% of 2900 calories.
 Fat: Less than 97 grams of total fat and less than 26 grams
saturated fat.
 Vitamin and mineral recommendations based on individual
needs and deficiencies
Goals and Intervention
 Goal 1: Increase weight to at least UBW of 160-165 pounds,
with ultimate goal of 184 pounds (ideal body weight).
 Intervention 1:Increase caloric intake to at least 2900 calories,
which will allow a weight gain of at least 1 pound/week. Do this by
consuming smaller, more frequent meals, add in protein shakes and
hidden sources of calories.
 Goal 2: Alleviate signs and symptoms associated with oral
thrush
 Intervention 2: Avoid alcohol, high sugar and yeast foods, and foods
that are hot, spicy, tough, and difficult to chew and swallow.
Sample Diet and Modifications
Breakfast
-Scrambled eggs with hot salsa
-Crisp bacon
-Apple
-Orange juice
Lunch
-Spaghetti with sauce
-White roll
-Chocolate ice cream
Dinner
-Steak and potatoes
-Raw carrot sticks
-Beer
When is Enteral Nutrition Necessary?
 Enteral Nutrition may be considered when BMI drops below 18.5
kg/m2
 Enteral nutrition may be considered when a weight loss of greater
than 5% occurs in a 3 month period.
 Enteral nutrition may be considered when BCM (Body Cell Mass)
decreases by more than 5% in 3 months.
 Can be considered if Oral Thrush worsens to the point that patient
is unable to consume adequate nutrition from food sources
 Can be considered in malnourished AIDS patients with chronic,
uncontrollable diarrhea.
Education and Counseling
 Focus on diet modification and food safety
 Provide patient with food/drug and supplement interactions
information and symptom management information
 Food safety suggestions
 What would you advise?
Monitor and Evaluation
 BMI, body composition changes, skin fold measurements
 Pertinent lab values: CD4 count, viral load, albumin, glucose,
cholesterol, etc.
 Signs and symptoms like diarrhea and fatigue
 Development of additional opportunistic infections
 Oral thrush, pneumonia, AWS
 Evaluate patient’s adherence to diet modifications and
exercise
Prognosis
 Weight loss and AWS is not inevitable.
 Opportunistic infections and other complications of AIDS will
always affect nutritional status, so nutrition therapy and
continuing education will be important for patient’s entire life
 Life expectancy depends on how early patient began ARV,
and how well they are able to prevent nutritional
complications and OI.
 Life expectancy is near normal today if disease is properly
managed
Resources
 Resources
Alcohol and HIV/AIDS. National Institute of Alcohol Abuse and Alcoholism. (2002).
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http:pubs.niaaa.nih.gov/publications/aa57.htm
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Body Fat Percentages. Vanderbuilt University (2012). http://
healthandwellness.vanderbilt.edu/news/2011/09/body-fat-percentage/
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HIV. Centers for Disease Control and Prevention. (2013). http://www.cdc.gov/hiv/. HIV
Infection. U.S. National Library of Medicine. (2012). http://www.nlm.nih.gov/
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medlineplus/ency/article/000682.htm

Nelms, Sucher, Lacey, Roth; (2011)Nutrition Therapy & Pathophysiology, (2nd ed.)
Belmont, Ca, Brooks/Cole Cengage Learning
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Mahan, Escott-Stump, Raymond, (2012) Food and the Nutrition Care Process, St. Louis,
Mo, Elsevier Saunders