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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
HIV/AIDSEtisa AM, PS Ilmu Gizi 3
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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
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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.
HIV/AIDSEtisa AM, PS Ilmu Gizi
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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 $e)ien)ies 7!itamins A,F
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2
#alnutrition and
HIV/AIDS AKe)t t#e -o$ 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 $uin" HIV&in*e)tion Ene" in)easeB
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3<
Early Stage
Sa*e *oo$ 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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3
#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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3+
%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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35
$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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2
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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5
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-
HIV/AIDSEtisa AM, PS Ilmu Gizi 40
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*
HIV/AIDSEtisa AM, PS Ilmu Gizi
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
HIV/AIDSHesti M', PS Ilmu Gizi 4
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
HIV/AIDSHesti M', PS Ilmu Gizi 44
&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