Nutrition Therapy Related to fwwsHIV 2016

8/18/2019 Nutrition Therapy Related to fwwsHIV 2016

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The human immunodeficiency virus (HIV) is a retrovirus that infects

cells of the immune system, destroying or impairing their function.

As the infection progresses, the immune system becomes weaer,and the person becomes more susceptible to infections.

The most advanced stage of HIV infection is ac!uiredimmunodeficiency syndrome (AI"#).

It can tae $%&$' years for an HIV&infected person to develop AI"#antiretroviral drugs can slow down the process even further.

HIV/AIDSEtisa AM, PS Ilmu Gizi 2


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In 2009, 33.3 million people wee li!in"wit# HIV in t#e wol$.

3.% million people wee li!in" wit#HIV/AIDS in t#e Sout#&East Asia 'e"ion in2009

(omen a))ount *o 3+ o* t#e totalnum-e.

In$ia, In$onesia, Manma, epal an$ #ailan$ a))ount *o t#e ma1oit o* HIVin*e)tions

In In$onesia, t#e HIV epi$emi) is still ont#e ise



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Epidemiology : Indonesia

#e ma1oit o* HIV in*e)tions aetransmitted sexually

Injecting drug use is t#e se)on$most )ommon mo$e o* HIVtansmission

HIV/AIDSEtisa AM, PS Ilmu Gizi


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HIV/AIDSHesti M', PS Ilmu Gizi %


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HIV/AIDS 4


7/67HIV/AIDSEtisa AM, PS Ilmu Gizi +


8/67HIV/AIDSEtisa AM, PS Ilmu Gizi 5


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indow period * time between infection,

Ab detection+ An infected person can infect others

within wees of initial HIV e-posure, at a time well

before anti&HIV Abs can be detected.

Average time from initial infection to AI"# is

about $% years, though this rate of

development is lengthening with newtreatments available.


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HIV is transmitted t#ou"#

unpote)te$ se6ual inte)ouse 7-ot##eteose6ual an$ #omose6ual anal o!a"inal8,

tans*usion o* )ontaminate$ -loo$,

s#ain" o* )ontaminate$ nee$les, ansplantation o* in*e)te$ tissues o o"ans.

-etween a mot#e & #e in*ant $uin"pe"nan), )#il$-it# -east*ee$in"

Mot#e to *etus, peinatal tansmission!aia-le, $epen$ent on !ial loa$ an$mot#e:s ;D )ount.



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Transmission


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Etisa AM, PS Ilmu Gizi


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What is the linkbetween HIV and AIDSand Nutrition?


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Link between HIV and AIDS andNutrition Eal $ete)tion o* HIV po!i$es an oppotunit to

-uil$ up good nutritional status an$ #ealt#eatin" #a-its

ood nutrition is a *om o* immune pote)tion,espe)iall impotant in t#e pesen)e o* HIV

#e meta-olism o* a peson li!in" wit# HIV is altee$

I* nutitional nee$s ae not met, t#e -o$ is moesus)epti-le to in*e)tions an$ ma ta>e lon"e to

e)o!e *om mino illnesses

#is lea$s to a ))le o* moe wei"#t loss, moe!ulnea-ilit, an$ wosenin" illness


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?ne o* t#e most common signs o! HIV"rogression is weight loss

@ne6plaine$ wei"#t loss 7


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HIV and Nutrition:Effects on the Immune System

HIV po"essi!el $estos t#e immunesstem, lea$in" to oppotunisti)in*e)tions 7?I8 an$ $e-ilitation.

Pe&e6istin" un$enutition ma>es it$i)ult *o PHIV to sta #ealt# an$po$u)ti!e.

Fot# HIV an$ un$enutition limit t#ea-ilit to "#t in*e)tion an$ sta #ealt#.


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Essential Nutrients

e, in*e)tions,an$ !ial epli)ation

Increased$ulnerability to

in!ection an$in)ease$ *euen)

an$ $uation o*oppotunisti) in*e)tions

HIV


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Essential Nutrients


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Effect of HIV/AIDS onNutrition:Reduced Asorption HIV is asso)iate$ wit# e$u)e$

a-soption o* *oo$/nutients ;ause$ - HIV in*e)tion, ?Is an$ A'

Me$iate$ - $ia#ea an$ $ama"e tointestinal )ells

'esults in poo a-soption o* *ats

'e$u)es a-soption o* *at&solu-le!itamins, su)# as !itamins A an$ E


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AIDS"Associated !astingSyndrome

In)eases mo-i$it an$ motalit

Asso)iate$ wit#

− 'e$u)e$ ene" inta>e

− In*e)tions an$ "astointestinal $iso$esin)lu$in" $ia#ea an$ mala-soption

− Meta-oli) )#an"es

22


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#alnutrition and

HIV/AIDS ow FMI is asso)iate$ wit# $isease

po"ession an$ $eat#

utient $e)ien)ies 7!itamins A,F


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#alnutrition and

HIV/AIDS AKe)t t#e -o$ in simila was AKe)t t#e a-ilit o* t#e immune sstem

to "#t in*e)tion an$ >eep t#e -o$

#ealt# t#ou"#B Disupts ;D num-e / *un)tion Disupts ;D5 num-e / *un)tion Altes $elae$ tpe )utaneous

#pesensiti!it Altes ;D / ;D5 atio Impais anti-o$ esponse Impais -a)teia >illin"


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Major Target Cells for HIV

Infection

/"01 T&2ymphocytes

/"01 monocytes and macrophages (inclu.

microglia)

/"01 "endritic cells (inclu. 2angerhans cells)


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3-pressed on T&helper lymphocytes

signaling other cells in immune system

healthy+ 4%%5$%% /"01 T cells6mm7

AI"#+ 8 %% /"01 T cells6mm7


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Nutrition in the Different Phasesof HIV

2+


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Nutition in t#e DiKeent P#ases o* H

Asmptomati) p#aseB Ene" an$nutient nee$s in)ease -e)ause o* !iusepli)ation

Smptomati) p#aseB Ene" an$ nutientnee$s in)ease e!en moe -e)ause o*!ius epli)ation an$ t#e eKe)ts o* HIV&elate$ smptoms

25


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Early Stage

o smptoms, sta-le wei"#t

In)ease$ nutitional euiements $uin" HIV&in*e)tion Ene" in)easeB


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Early Stage

Sa*e *oo$ an$ wate #an$lin" pa)ti)es (as# #an$s -e*oe pepain" an$ eatin" *oo$,

a*te usin" t#e toilet o )#an"in" nappies o

$iapes (as# all *oo$ pepaation su*a)es, utensils an$

$is#es

(as# all *uit an$ !e"eta-les -e*oe eatin",)oo>in" o se!in"

A!oi$ lettin" aw *oo$ )ome in )onta)t wit#)oo>e$ *oo$

;oo> *oo$ t#oou"#l 7espe)iall )#i)>en an$meats8


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Early Stage

Sa*e *oo$ an$ wate #an$lin"pa)ti)es )ontinue$ Se!e *oo$ imme$iatel a*te pepaation

eep *oo$ )o!ee$ an$ awa *ominse)ts, o$ents an$ ot#e animals

Do not stoe )oo>e$ *oo$

@se sa*e wate *o $in>in", )oo>in", an$)leanin" $is#es an$ utensils

e!e use -ottles wit# teats *o *ee$in"in*ants use a )up instea$


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#iddle Stage

Si"ni)ant, unintentional o un$esia-lewei"#t loss as a esult o* oppotunisti)in*e)tions

Main o-1e)ti!eB minimize )onseuen)es In)ease nutient inta>e *o e)o!e/wei"#t "ain Maintain inta>e $uin" peio$s o* a)ute illness an$

$epesse$ appetite In)ease nutition inta>e "a$uall to pomote

wei"#t an$ mus)le mass "ain, an$ nutitionale)o!e Ma>e e!e -ite )ount

Dail !itamin&mineal supplements

;ontinue p#si)al a)ti!it as a-le


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#iddle Stage

Mana"e an$ teat t#e smptoms t#ataKe)t *oo$ inta>eB

See> me$i)al attention imme$iatel i* Dia#ea is pesistent an$/o

a))ompanie$ - *e!e Ce!e lasts *o moe t#an 3 $as Mout# an$ t#oat soes ae pesent

A!oi$ un#ealt# -e#a!ios Al)o#ol, smo>in" an$ $u" use @nsa*e se6ual pa)ti)es


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3%

$ate Stage

Smptomati), *ull&-lown AIDS $isease

Main o-1e)ti!eB po!i$e )om*ot opalliati!e )ae eat all in*e)tions t#at aKe)t inta>e

Mo$i* $iet a))o$in" to smptoms

Maintain inta>e $uin" peio$s o* a)uteillness an$ $epesse$ appetite

En)oua"e eatin" an$ p#si)al a)ti!it asa-le

Po!i$e ps)#olo"i)al an$ emotional suppot


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%oals of Nutrition &are andSupport

Impo!e eatin" #a-its an$ $iet toB

Maintain wei"#t, pe!ent wei"#t loss

Pese!e mus)le mass Fuil$ stoes o* essential nutients


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%oals of Nutrition &are andSupport

Pe!ent *oo$&-one illnesses -pomotin" H"iene

Coo$ an$ wate sa*et

Mana"e smptoms aKe)tin" *oo$inta>e - eatin" oppotunisti) in*e)tions

eatin" pain


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$oss of Appetite

Eat small, *euent meals t#ou"#outt#e $a 7%&4 meals/$8

Ma>e e!e -ite )ountJ Din> plent o* liui$s a>e wal>s -e*oe meals N t#e *es#

ai #elps to stimulate appetite

Ha!e *amil o *ien$s assist wit#*oo$ pepaation

Mout# )ae is a$!isa-le


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Sore #outh and Throat

A!oi$ )itus *uits, an$ a)i$i) o spi)*oo$s

Eat *oo$s at oom tempeatue o)ol$

Eat so*t an$ moist *oo$s

A!oi$ )aKeine an$ al)o#ol

Ceuent mout# )ae


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Diarrhea

Eat *oo$s t#at ta!el slowl t#ou"# t#e$i"esti!e ta)t an$ $e)ease stimulation o*t#e -owel Fananas, mas#e$ *uits, so*t w#ite i)e, poi$"e

Eat smalle meals, moe o*ten

Eliminate mil> an$ mil> po$u)ts to see i*smptoms impo!e

A!oi$ inta>e o* *ie$ an$ #i"# *at *oo$s

Don:t eat *oo$s wit# insolu-le -e7ou"#a"e8 Co e6ampleB a>e t#e s>in oK *uits an$

!e"eta-les


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Diarrhea

Din> plent o* Oui$s 75&s, $in> $ilute$ 1ui)e

instea$ A!oi$ !e #ot o !e )ol$ *oo$s

I* $ia#ea is se!ee

Gi!e oal e#$ation solution Coo$ ma -e wit##el$ *o 2 #s o esti)te$

to onl )lea Oui$s 7soups o tea8 o so*t *oo$s7mas#e$ *uit, potatoes, w#ite i)e, poi$"e8


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3

(e'er

Din> plent o* Oui$s

Eat small *euent meals, in)lu$in"

sna)>s -etween meals As toleate$ at e"ula inte!als

Mout# )ae is a$!isa-le

A$$ sna)>s -etween meals


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Altered Taste

@se Oa!o en#an)es su)# as saltan$ a !aiet o* #e-s an$ spi)es

$iKeent te6tues o* *oo$ ;#ew *oo$ well an$ mo!e it aoun$

t#e mout# #is stimulates taste e)eptos


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%

)oor (at Asorption

Eliminate oils, -utte, ma"aine, "#ee,an$ *oo$s t#at )ontain o wee pepae$wit# t#em

Eat lean meats im all !isi-le *at an$ emo!e s>in *om

)#i)>en

A!oi$ $eep *ie$, "eas, an$ #i"# *at*oo$s

Eat *uits an$ !e"eta-les an$ ot#e low&*at *oo$s.


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4

(atigue* $ethargy

I* possi-le, #a!e someone pe&)oo>*oo$s #is will #elp t#e patient )onse!e ene"

Eat *es# *uits t#at $on:t euiepepaation in&-etween meals

Eat smalle, moe *euent meals an$sna)>s t#ou"#out t#e $a

E6e)ise as a-le #is will in)ease ene"

to eat at t#e same time ea)# $a.


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+

Some Recommended (oods

Food Group Food

Protein (body-building

foods)

All animal products, fis, dairyproducts, l!gum!s (b!ans, l!ntils),

groundnuts and coo"!d !ggs

Carbohydrate (!n!rgy-gi#ingfoods)

$r!ads, c!r!als (maiz!, mill!t,%!at, sorgum), ric!, noodl!s,potato!s, cassa#a, yam, s%!!tpotato!s, plantain


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Some Recommended (oods

Food Group Food

Fruits/Vegetables(sourc! of many #itaminsand min!rals)

Any fruits or #!g!tabl!s

Fats/Oils (sourc! of

fat solubl! #itamins A, E,& '" and !n!rgy)

Palm oil, #!g!tabl! oils,

margarin!, butt!r, g!!


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9

(oods to A'oid

'aw e""s

@n$e)oo>e$ )#i)>en an$ meats o aw, ae, o me$ium ae meats

(ate t#at is not -oile$ o 1ui)es t#at aema$e *om wate t#at is not -oile$.

Al)o#ol an$ )oKee

un>J *oo$s su)# as )#ips, -is)uits, an$

sweets wit# little nutitional !alue Coo$s t#at a""a!ate smptoms elate$ to

$ia#ea, nausea/!omitin", -loatin", loss o*appetite, an$ mout# soes


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%0

Nutrition and #edication

Me$i)ations use$ to teat HIV oppotunisti)in*e)tions ma )ause $u"&nutientintea)tions o si$e eKe)tsB

Vitamin F4 supplementation s#oul$ -ea$ministee$ wit# isoniazi$ t#eap *otu-e)ulosis to a!oi$ Vitamin F4 $e)ien)

Ion& an$ zin)&)ontainin" supplements s#oul$

not -e ta>en wit# )ipoOo6a)in

Sul*a$o6ine an$ Pimet#amine 7Cansi$a8 isnot e)ommen$e$ unless *olini) a)i$supplement is "i!en


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Nutrition and #edication

+,- Antieto!ial $u"s ma #a!eB Dieta euiements 7e."., wit# o

wit#out *oo$8

Si$e eKe)ts wit# nutitional)onseuen)es su)# as $ia#ea onausea/!omitin"

An eKe)t on e$ -loo$ )ell po$u)tion)ausin" anemia 7e."., Qi$o!u$ine & AQ8

Nutrient re.uirements for HIV in


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Nutrient re.uirements for HIV inrelation to Normal DietaryRe.uirements

RA$apte$ *om (H?, 2003B utient euiements *o People i!in" wit# HIV/AIDS, 'epot o* te)#ni)al)onsultation. Gene!a, (H?. 'e*e to t#is $o)ument *o $etails an$ $is)ussions on nutient

euiements

N i i d i d l i f f h


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Nutrition during pregnancy and early infancy for those

affected by HIV (WHO, 2010)

he best !ay to approach nutritional care and pre"ent #other$to$childtrans#ission of HIV%

&ppropriate health care during pregnancy (with A9T)

'reastfeeding e-clusively in the first : months and continue up to at least a

year

eplace#ent feeding if acceptable, feasible, affordable, sustainable and safe(A;A##)

&sy#pto#atic HIV positive lactating women re!uire the sa#e increase in

rations and #icronutrients as HIV&ve lactating women, plus an additional $%


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%

The #ultidisciplinary

Team A multi$is)iplina team is )u)ial toa$$ess t#e man )omple6 an$ !aie$*a)tos in t#e )ae o* HIV&in*e)te$

patients an$ t#ei *amilies Ea)# mem-e o* t#e team )an #elp

a$$ess t#ese issues in t#ei own waB

uses an$ nutitionists ;ounselos

;ommunit wo>es an$ a"en)ies

*ym"hadeno"athy*ym"hadeno"athy


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*ym"hadeno"athy*ym"hadeno"athy

HIV/AIDSEtisa AM, PS Ilmu Gizi %%

Skin and oral diseaseSkin and oral disease


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Skin and oral diseaseSkin and oral disease

HIV/AIDSHesti M', PS Ilmu Gizi %4


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Her"es +oster ,shingles-Her"es +oster ,shingles-

HIV/AIDSHesti M', PS Ilmu Gizi %+

( l . didi i( l . didi i


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(ral .andidiasis(ral .andidiasis

HIV/AIDSEtisa AM, PS Ilmu Gizi %5


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HIV/AIDSHesti M', PS Ilmu Gizi %9


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In!eksiIn!eksi

.ytomegalo.ytomegalo$irus$irus

,retina-,retina-


Her"es Sim"lex Virus In!x/Her"es Sim"lex Virus In!x/


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Her"es Sim"lex Virus In!x/Her"es Sim"lex Virus In!x/

HIV/AIDSHesti M', PS Ilmu Gizi 4<

#0*#0*


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#0*#0*


42


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Non1tuberculousNon1tuberculous

mycobacterial in!x/mycobacterial in!x/

HIV/AIDSHesti M', PS Ilmu Gizi 43

*im!oma maligna non1*im!oma maligna non1


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*im!oma maligna non1*im!oma maligna non

Hodgkin sel 2Hodgkin sel 2


0 i1 +0S-


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0aposi1s sarcoma +0S-

aposi:s sa)oma7s#own8 is a ae)an)e o* t#e -loo$!essels t#at is

asso)iate$ wit# HIV. Itmani*ests as -luis#&e$ o!al&s#ape$pat)#es t#at ma

e!entuall -e)omet#i)>ene$. esionsma appea sin"l oin )lustes.

Disseminated 0ycosisDisseminated 0ycosis


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Disseminated 0ycosisDisseminated 0ycosis


&onclusions


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&o c us o s

HIV aKe)ts nutition -B

− 'e$u)in" *oo$ )onsumption− Impaiin" nutient a-soption

− In)easin" ene" nee$s

− ;ausin" HIV&asso)iate$ wastin"

− ;#an"in" meta-olism− ;#an"in" -o$ )omposition

Poo nutition aKe)ts HIV -B− De)easin" immunit

− Slowin" t#e #ealin" po)ess− Possi-l #astenin" $isease po"ession

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Nutrition Therapy Related to fwwsHIV 2016

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