Nutritional Implications of HIV/AIDS

Presented by Sharmaine E. Edwards

Director, Nutrition ServicesMinistry of Health, Jamaica

2006 March 29

Outline Causes and manifestations of

malnutrition in HIV/AIDS

Managing Nutrition and Food-related Problems

Antiretroviral Medications and Food-Drug Interactions

Introduction Nutritional problems are prevalent Complex, multi-factorial etiology Negative impact on immunity &

overall health Decreased quality of life and ability

to perform activities of daily living Increased health care costs

Link Between Malnutrition & HIV/AIDS

Malnutrition

Wasting

Decreased Immunity

Opportunistic Infections

Increased risk of mortality

Increased requirements

Decreased Intake

Increased losses

HIV

Disease progression to AIDS

Malnutrition in HIV/AIDS Starvation

inadequate energy intake or malabsorption adaptation to conserve energy and protein responds to refeeding

Cachexia sepsis, trauma, neoplasm increased metabolic rate and hypercatabolism

of somatic protein treat infection to improve response to feeding

Causes of MalnutritionInadequate Dietary Intake Loss of appetite Gastrointestinal complications

Nausea Early satiety Delayed gastric emptying

Oral/esophageal complications Herpes, Candidiasis, CMV Abnormal taste, dental problems

Eating disorders

Causes of MalnutritionIncreased Nutrient Losses

Diarrhoea Side effect of medications Opportunistic infections HIV enteropathy

Malabsorption Carbohydrates, protein, fats, micronutrients, electrolytes Possible in asymptomatic individuals

Vomiting Opportunistic infections Side effects of medications

Sweats Lose electrolytes and fluids

Causes of MalnutritionIncreased Requirements

Energy Elevated with high viral load, opportunistic

infection and need to gain weight, activity Protein

Elevated for immune cell replication, maintenance of lean body mass, during periods of opportunistic infection

Micronutrients Elevated to treat deficiencies and may have a

role in preventative therapy

Causes of MalnutritionOther Factors Metabolic abnormalities

Drug-food interactions and side effects Nausea, stomach ache, & early satiety Diarrhea, bloating, malabsorption Neuropathy and limited mobility

Co-morbidities

Causes of MalnutritionOther Factors

Special needs groups pregnancy, lactation, childhood

Socioeconomic factors Poverty, homelessness Illicit drug use

Manifestations of MalnutritionWeight Loss

Lose adipose and lean tissue Typical pattern 60% adipose, 40% lean

Acute or rapid weight loss is linked to opportunistic infections

Chronic or slow weight loss is linked to gastrointestinal disease or high viral load

Implications of Weight Loss 3% change = normal variation 5% unintentional loss = risk for

wasting, mortality, opportunistic infections

10% loss = wasting syndrome 20% loss with OI = hospitalization

Manifestations of Malnutrition Wasting Diverse clinical presentation Maladaptive response to reduced

intake Progressive loss of body cell mass Lipoatrophy associated with

lipodystrophy

Wasting due to systemic inflammatory response Neuroendocrine mediation:

catecholamines glucagon, growth hormone, corticosterone mobilize glucose, fatty acids, amino acids

Cytokine production anorexia & semi-starvation decreased muscle protein synthesis increased muscle protein catabolism

HIV-Associated WastingWasting Syndrome

10% weight loss in context of diarrhea/feverProposed definition for HIV-Wasting

>10% loss in 6 months >5% loss in 3 months > 3% loss in 1 month BMI < 20 loss of 5% Body Cell Mass (m) BCM < 35% total weight (BMI <27) (f) BCM < 23% total weight (BMI < 27)

Manifestations of MalnutritionMicronutrient Deficiencies Common, especially in persons with

CD4 < 200 Due to

Inadequate dietary intake Malabsorption Increased turnover Metabolic abnormalities

Associated with increased mortality and faster disease progression

Identify Nutritional Risk

Methods include Nutrition screening Classification of risk by category Subjective global assessment

Need to identify method, who will screen, and referral process

Conclusion Nutritional problems are common

and may be experienced in clusters

The etiology of malnutrition is complex

Nutrition screening identifies individuals in need of more in depth nutritional care