Hiv and nutrition

Important concepts

• Good nutrition is integrally linked to healthy living for people with HIV infection

• Nutrition is vital for growth and development in children

• Nutrients are required for immune system function

• Poor nutrition may accelerate HIV disease progression

• HIV disease may worsen poor nutritional status

objectives

• Nutrition and the immune system

• The components of nutritional assessment

• Barriers to adequate nutrition

• Nutritional support activities for the person living with HIV

Hiv and nutrient absorption

• Micronutrient deficiency compromises host immunity

• Impaired nutrient absorption occurs during infection

• HIV infected individuals require 10-15% more calories/day

• HIV infected individuals require 50-100% more protein/day

Nutritional impact of HIV

• Poor food intake

• Poor nutrient absorption

• Disruption of metabolism

• Chronic infection

• Muscle wasting or loss in lean body tissue

Barriers to nutrition

• Factors that increase metabolic demands– HIV infection itself– Fever– Acute illness

Barriers to nutrition

• Factors that decrease food intake– Mouth pain– Pain when swallowing– Nausea, abdominal pain– Diarrhea – Anorexia– Neurologic disease/dementia

Barriers to nutrition

– Economic realities:

– HIV may affect ability to earn a living

– HIV may lead to loss of assets

– HIV may lead to disruption of social networks

Barriers to nutrition

– Environmental realities:

–Famine

–Socio-political events

These may prevent access to food and/ or clean water

What can we do to help improve nutritional status given these obstacles?

– Assess which patients require more extensive nutrition management (“high risk” patients)

– Individualize nutrition care plans

What can we do to help improve nutritional status given these obstacles?

– Maximize food intake during HIV/AIDS related infections by diagnosing and treating the infection and counseling patients about which foods to eat

– Educate patients on ARV therapy about drug-food interactions

Nutritional assessment

– Weigh patient at each visit • Record weight and body mass index (BMI) at each visit• Use growth curves to monitor infants and children

– Observe clinical condition – Ask about food intake/ hunger– Ask about specific symptoms that may

prevent food intake

Simple nutritional assessment

Visit 1 2 3 4 5 6 7

weight

50kg 50kg 53kg 53kg 55kg 55kg 56kg

Hb 8 10

CD4 80 200

Initiation of ARV’s

Acute illness

Visit no.

1 2 3 4 5 6 7

Weight

55kg 55kg 51kg 52kg 55kg 55kg 56kg

Hb 8 8

CD4 350 260

High risk signs and symptoms

• Appetite loss• Weight loss• Diarrhea• Pain when swallowing (odynophagia) • Difficulty swallowing (dysphagia)• Dehydration• Clinical signs of nutrient deficiency• Loss of muscle mass.

Individualize the nutrition care plan

– Understand factors which may influence your patients’ ability to eat a sufficient diet

– Know what foods your patient population consumes and how the food is prepared

– Know what foods are locally available, palatable, affordable and can be realistically incorporated into the diet

Maximise food intake in acute illness

– Food-based symptom management is universal

– Locally available foods that can be easily incorporated into the diet vary from region to region

– Try to provide patients with available nutrient dense foods that help alleviate their acute symptoms

Case study-possible interventions

• Provide medication for the symptoms– Antimotility agents– Antibiotics (if acute bacterial infection suspected)

• Assess Mr. L’s current diet by reviewing food eaten in the past three days

• Assess access to clean water• Provide information on food and water hygiene• Suggest alternate locally available foods that

help alleviate diarrhea

Maximizing food intake

• Loose bowels and diarrhea: patient counseling– Eat starchy foods such as bananas, soft rice,

porridge, maize, sorghum, potato, cassava, and blended foods like corn-soy blend

– For protein, eat eggs, chicken or fish– May need to reduce dairy products until

diarrhea subsides– Decrease high fat foods, boil and steam

versus frying

Maximising food intake -ct

– Avoid caffeine (coffee and teas) and alcohol– Drink liquids often to avoid dehydration

(soups, diluted fruit juices, boiled water)– Consume foods that help retain fluid such as

millet, banana, peas and lentils– Eat fermented foods such as yogurt, sour milk

etc– Limit gas forming foods such as cabbage,

onions, soda

Summary

• Malnutrition can contribute to and result from progression of HIV disease

• A nutrition action plan the includes a surveillance system, individualized care plans, food-related symptom management guidelines and food-drug related information may have positive effects on: