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Care of Women with HIV Living in Limited-Resource Settings
HIV and Nutrition: Care and Support
Dorcas Lwanga, MSc, RDNutrition Advisor
Academy for Educational Development
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Objectives
Review goals and components of nutrition care and support
Discuss nutrition recommendations for the symptoms associated with each stage of HIV disease
Provide information on how to manage nutrition-related symptoms of HIV
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Role of Nutrition Care and Support
Studies have shown that the clinical outcome of HIV is poorer in individuals with compromised nutrition
Improving nutrition can help prevent weight loss, strengthen the immune system and delay HIV disease progression.
Nutrition care should be part of a comprehensive program that helps the HIV-infected individual and her family
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Goals of Nutrition Care and Support
Improve nutritional status Maintain weight, prevent weight loss Preserve muscle mass
Ensure adequate nutrient intake Improve eating habits and diet Replenish stores of essential nutrients
Prevent food-borne illnesses Enhance quality of life
Treat opportunistic infections Manage symptoms affecting food intake
Provide palliative care
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Components of Nutritional Care and Support
Nutrition assessment Weight Mid-arm circumference
Nutrition education and counseling Adequate diet Proper food handling and safety
Hygiene Water Sanitation
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Components of Nutritional Care and Support continued
Nutrition supplementation Food Vitamin and mineral supplements
Food and nutrition support for families Food-for-work Community kitchens
Home-based care Food baskets Home-delivered, ready to eat meals
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Stages of HIV Disease and Nutrition
Specific nutrition recommendations vary according to the underlying nutritional status and extent of HIV disease progression: Early - no symptoms, stable weight Middle - weight loss Late - symptomatic AIDS
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Nutrition Care and Support Priorities by Stage of Disease
Early stage – “stay healthy” Build stores of essential nutrients Maintain weight and lean body mass Ensure understanding of food and water safety
Middle stage – “minimize consequences” Maintain dietary intake during acute illness Increase nutrient intake for recovery/weight gain Continue physical activity
Late stage – “provide comfort” Treat opportunistic infections Modify diet according to symptoms Encourage eating and physical activity
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Recommendations for Nutrition Care and Support: Early Stage
Identify locally available and acceptable foods Promote a diet adequate in energy, protein and other
essential nutrients Energy requirements are increased by 10-15% Protein requirements are increased ~ 50% Requirements for vitamins and minerals used by the immune
system are also increased
Maintain physical activity Weight-bearing exercise builds lean body mass Exercise stimulates appetite
Prevent food-borne illnesses through safe food handling practices
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Recommendations for Safe Food Handling Practices
Wash hands before preparing and eating food, after using the toilet or changing nappies or diapers
Wash all food preparation surfaces, utensils and dishes
Wash all fruit and vegetables before eating, cooking or serving
Avoid letting raw food come in contact with cooked food
Cook food thoroughly Serve food immediately after preparation
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Recommendations For Safe Food Handling Practices continued
Keep food covered and away from insects, rodents and other animals
Do not store cooked food Always use boiled or bottled water for drinking,
cooking, and cleaning dishes and utensils Never use bottles with teats for feeding infants. Use
a cup instead
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Recommendations for Nutrition Care and Support: Middle Stage
Maintain intake during periods of acute illness and depressed appetite
Increase nutrition intake to promote weight and muscle mass gain, and nutritional recovery Make every bite count Daily vitamin-mineral supplements
Continue physical activity as able
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Recommendations for Nutrition Care and Support: Middle Stage continued
Manage the symptoms that affect food intake Loss of appetite Nausea Mouth sores Diarrhea
Seek medical attention immediately High fever or fever for more than 3 days Persistent diarrhea Other symptoms of infection
Avoid unhealthy behaviors Alcohol, smoking and drug use Unsafe sexual practices
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Recommendations for Nutrition Care and Support: Late Stage
Treat all infections that affect appetite, ability to eat and retention of nutrients Consider the food and nutritional interactions with medicines Consider the side effects of medications that affect intake
Maintain intake during periods of acute illness and depressed appetite
Modify diet according to symptoms Encourage physical activity Provide psychological and emotional support
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Recommendations for Symptom-Based Nutrition Care and Support
Symptom Nutritional StrategyLoss of appetite Eat small, frequent meals throughout the day (5-6 meals/d)
Eat nutritious snacks whenever possible - “make every bite count” Drink plenty of liquids Take walks before meals – the fresh air helps to stimulate appetite Have family or friends assist with food preparation
Sore mouth and throat
Avoid citrus fruits, acidic and spicy foods Eat foods at room temperature or cold Eat soft and moist foods Avoid caffeine and alcohol
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Recommendations for Symptom-based Nutrition Care and Support continued
Symptom Nutritional StrategyNausea and vomiting
Eat small, frequent meals (avoid an empty stomach as this makes the nausea worse)
Eat dry bread or toast, and other plain dry foods, preferably in the morning before getting out of bed
Avoid foods with strong or unpleasant odors Avoid fried foods Drink plenty of liquids Rest and relax after and between meals Avoid lying down immediately after eating (wait for at least 1-2
hours) Avoid coffee and alcohol
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Recommendations for Symptom-Based Nutrition Care and Support continued
Symptom Nutritional StrategyDiarrhea Eat bananas, mashed fruits, soft white rice, porridge
Eat smaller meals, more often Eliminate milk and milk products to see if symptoms improve Avoid intake of fried and high fat foods Don’t eat foods with insoluble fiber (“roughage”) - take the skin off
fruits and vegetables Drink plenty of fluids (8-10 cups/day) Give oral rehydration solution if diarrhea is severe Avoid sweet drinks Drink diluted juice Avoid very hot or very cold foods (they stimulate the bowels)
If diarrhea is severe, food may be withheld for 24 hrs or restricted to only clear fluids, such as, soups, tea or soft foods (mashed fruit, potatoes, white rice, porridge)
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Recommendations for Symptom-Based Nutrition Care and Support continued
Symptom Nutritional Strategy
Fever Drink plenty of fluids Eat small frequent meals as tolerated Add snacks between meals
Altered Taste Use a variety of herbs and spices to enhance the flavor of the food
Try different textures of food Chew food well and move around mouth to stimulate
receptors
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Recommendations for Symptom-Based Nutrition Care and Support continued
Symptom Nutritional StrategyPoor fat absorption
Eliminate oils, butter, margarine, ghee and foods that contain or were prepared with them
Eat lean meats. Trim all visible fat and remove skin from chicken Avoid deep fried, greasy and high fat foods Eat fruit and vegetables and other low-fat foods
Fatigue, lethargy
If possible, have someone pre-cook foods Eat fresh fruits that don’t require preparation in between meals Eat smaller, more frequent meals and snacks throughout the day Exercise as able to increase energy Try to eat at the same time each day
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Source of Various Vitamins and Minerals
Vitamin Source
Vitamin A Cheese, butter, red palm oil, eggs, liver, carrots, mangos, papaya, pumpkin, green leafy vegetables, yellow sweet potatoes
Beta-Carotene Carrots, dark green vegetables, orange fruits, sweet potato, pumpkin, mango, papaya (paw-paw)
Vitamin B6Beans, potatoes, meats, fish, chicken, shellfish, watermelon, maize, avocado, broccoli, green leafy vegetables
Folate (Folic Acid)
Liver, green leafy vegetables, fish, legumes, groundnuts, meat, beans
Vitamin B12Meat, fish, chicken, shellfish, cheese, eggs, milk
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Source of Various Vitamins and Minerals continued
Vitamin Source
Vitamin C Citrus fruits; cabbage, green leaves, tomatoes, peppers, potatoes
Vitamin E Vegetable oils, green leafy vegetables, whole grain products, butter, liver, eggs, milk fat, groundnuts, other nuts
Iron Red meat, liver, fish, chicken, shellfish.
Zinc Meats, fish, chicken, shellfish, whole grain cereals, legumes, groundnuts, milk, cheese, yoghurt, vegetables
Selenium Meat, eggs, seafood, whole cereals, dark green vegetables, seafood
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Some Recommended Foods
Food Group FoodProtein(body-building foods)
All animal products, fish, dairy products, legumes (beans, lentils), groundnuts and cooked eggs
Carbohydrate(energy-giving foods)
Breads, cereals (maize, millet, wheat, sorghum), rice, noodles, potatoes, cassava, yam, sweet potatoes, plantain
Fruits/Vegetables (source of many vitamins and minerals)
Any fruits or vegetables
Fats/Oils(source of fat soluble vitamins A, E, D & K and energy)
Palm oil, vegetable oils, lard, margarine, butter, ghee
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Recommendations on Foods to Avoid
The aim of good nutrition care and support is to ensure adequate intake and to maintain weight and lean body mass. Therefore, other than the following, no foods should be eliminated unnecessarily.
Raw eggs Foods that have not been thoroughly cooked, especially meats
and chicken Water that is not boiled or juices that are made from water that is
not boiled Alcohol and coffee “Junk” foods such as chips, biscuits and sweets with little
nutritional value Foods that aggravate symptoms related to diarrhea,
nausea/vomiting, bloating, loss of appetite, and mouth sores
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Nutrition and Medication
Medications used to treat HIV opportunistic infections may result in negative drug-nutrient interactions or cause side effects.
Vitamin B6 supplementation should be administered with isoniazid therapy for tuberculosis to avoid Vitamin B6 deficiency
Iron and zinc-containing supplements should not be taken with ciproflaxacin
Sulfadoxine and Pyrimethamine (Fansidar) used for treatment of malaria is not recommended if the patient is folate deficient.
Some antiretroviral drugs have: Dietary requirements Side effects with nutritional consequences An effect on red blood cell production, increasing risk of anemia (e.g.
Zidovudine (AZT)).
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Summary
Maintaining adequate nutrition may be one of the most important things a newly infected person can do to prolong well-being.
Good nutrition and healthy lifestyle can: Preserve health Improve quality of life Prolong independence Delay disease progression
Prevention of food and water-borne infections reduces the risk of diarrhea, a common cause of weight loss, malnutrition and HIV disease progression in people living with HIV and AIDS.
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Summary continued
Managing common symptoms related to HIV/AIDS can minimize their impact on nutritional status.
Continuing physical activity and exercise, as appropriate, increases energy, stimulates appetite and preserves and builds lean body mass.
Providing psychosocial and emotional support as part of nutrition care at all stages of HIV disease can help to improve quality of life.
Nutritional care and support should be part of a comprehensive program that deals with the needs of the patient and her family.