Medical Nutrition Therapy for Human Immunodeficiency Virus (HIV) Disease

Medical Nutrition Therapy for Human Immunodeficiency Virus (HIV) Disease

Medical Nutrition Therapy for Human Immunodeficiency Virus (HIV) Disease

Chapter 41Chapter 41

© 2004, 2002 Elsevier Inc. All rights reserved.

Human Immunodeficiency VirusHuman 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.

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.


Acquired Immunodeficiency SyndromeAcquired 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.

AIDS is the final stage of HIV.

AIDS is a disease that prevents the body’s ability to fight off infection and illness.


HIV and AIDSHIV 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

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


HIV InfectionHIV Infection

30% to 60% develop an acute syndrome with malaise, fever, pharyngitis, lymphadenopathy, headache, myalgia, and sometimes a rash

30% to 60% develop an acute syndrome with malaise, fever, pharyngitis, lymphadenopathy, headache, myalgia, and sometimes a rash


Risk Factors for Contracting HIVRisk 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.

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.


People at Risk for HIVPeople 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

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


Acquired Immunodeficiency SyndromeAcquired 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

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


Diagnosis of HIV and AIDSDiagnosis 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

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


Symptoms of HIV and AIDSSymptoms of HIV and AIDS

Early: fever

Weight loss

Diarrhea

Flulike

Later: opportunistic infections

Malignancies

Early: fever

Weight loss

Diarrhea

Flulike

Later: opportunistic infections

Malignancies


Common Problems in HIV/AIDSCommon Problems in HIV/AIDS

Fungus infections: thrush

Meningitis

Pneumonia

Protozoal infections—infection in large and small bowels

Viral infections—herpes; shingles

Fungus infections: thrush

Meningitis

Pneumonia

Protozoal infections—infection in large and small bowels

Viral infections—herpes; shingles


LipodystrophyLipodystrophy

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

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


The goals of medical management of HIV are to: The goals of medical management of HIV are to:

HIV Medical ManagementHIV Medical Management

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

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


Nutritional AssessmentNutritional 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.

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.


Nutritional Assessment—cont’dNutritional 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.

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.


Nutritional Assessment—cont’dNutritional 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

Percent UBW more important than percent IBW—patients don’t lose fat as much as lean

TLC and delayed cutaneous hypersensitivity not helpful


HIV AssessmentHIV Assessment

Baseline status at diagnosis

Follow and reassess as complications develop

Consider mental status

Misinformation

Knowledge of food sanitation and good nutrition

Baseline status at diagnosis

Follow and reassess as complications develop

Consider mental status

Misinformation

Knowledge of food sanitation and good nutrition


General Goals of Nutrition Intervention in HIV DiseaseGeneral 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

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


Nutritional GoalsNutritional 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.

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.


Medical Nutrition Therapy Requires Six Distinct Components Medical Nutrition Therapy Requires Six Distinct Components

Screening

Referral

Assessment

Intervention

Outcomes evaluation

Communications

Screening

Referral

Assessment

Intervention

Outcomes evaluation

Communications


Management of Symptoms in HIV/AIDSManagement of Symptoms in HIV/AIDS

Nausea and vomiting

Loss of appetite

Sore mouth and throat

Diarrhea

Poor absorption of nutrients

Abdominal cramping

Weight loss

Nausea and vomiting

Loss of appetite


Diarrhea

Poor absorption of nutrients

Abdominal cramping

Weight loss


Eating Tips for Common SymptomsEating 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.

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.


Eating Tips for Common Symptoms—cont’dEating 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.


—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.


Suggested Diets for HIV/AIDS PatientsSuggested 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.

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.


Roles of the DietitianRoles 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.

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.


Wasting SyndromeWasting 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.

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.


Nutritional CalculationsNutritional 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

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


Nutritional Calculations—cont’dNutritional 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

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


Food Safety SuggestionsFood 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.

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.


Strategies for Reducing the Risk of CryptosporidiosisStrategies 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.


Nutrition-Related Complementary and Alternative TherapiesNutrition-Related Complementary and Alternative Therapies

Megadoses of vitamins and minerals

Antiviral AL-721 and homemade formulas

Dr. Berger’s Immune Power Diet and maximum immunity diet

Medical marijuana

Megadoses of vitamins and minerals

Antiviral AL-721 and homemade formulas

Dr. Berger’s Immune Power Diet and maximum immunity diet

Medical marijuana

Herbs/botanicals

—Astragalus

—Cat’s claw

—Echinacea

—Garlic

—Ginseng

—St. John’s wort Homeostatic

macrobiotic diet Yeast-free diet

Herbs/botanicals

—Astragalus

—Cat’s claw

—Echinacea

—Garlic

—Ginseng

—St. John’s wort Homeostatic

macrobiotic diet Yeast-free diet


Drug TherapyDrug 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

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


Drug Therapy—cont’dDrug 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

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


Drug Therapy for Involuntary Weight LossDrug 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.

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.


Referral information should include the following:Referral information should include the following:

Nutritional ReferralNutritional Referral

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

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


Referral information should include the following:Referral information should include the following:

Nutritional Referral—cont’dNutritional Referral—cont’d

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

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

Date post:	18-Jan-2016
Category:	Documents
Upload:	loc
View:	34 times
Download:	0 times

Medical Nutrition Therapy for Human Immunodeficiency Virus (HIV) Disease

Documents