Nutritional status and its effect on treatment outcome among HIV ...
NUTRITIONAL ASPECTS OF HIV CARE
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NUTRITIONAL ASPECTS OF HIV CARE
Nurses at the Forefront of HIV Care
18-19 March 2010Protea Court Yard Hotel
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Entry points for raising nutritional issues in providing care and support
During post testing
counselingWhen
coming fortreatment
for illnesses
Duringnutrition
educationDuring
Counseling for people with clinical AIDS
Part ofvoluntarycounselingand testingprogramme
Homevisits aspart of
home careself-help groups
and supportgroups for
carers
NURSE
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OutlineFood, nutrition, food groups & B. DietWhy nutrition and HIV? R’shipAspects of nutrition that matter in
HIV/AIDS situationAssessment of nutritional statusNutritional mgt of diet related
HIV/AIDS complicationsInfant feeding options in HIV
situation
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Nutrition, Food groups & Balanced Diet
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Source: Adapted from RCQHC and FANTA 2003
Vicious Cycleof Malnutrition and HIV
Poor Nutrition resulting in weight loss, muscle wasting, weakness, nutrient deficiencies
Increased Nutritional needs, Reduced food intake and increased loss of nutrients
Increased vulnerability to infections e.g. Enteric infections, flu, TB hence Increased HIV replication, Hastened disease progression Increased morbidity
Impaired immune system Poor ability to fight HIV and other infections, Increased oxidative stress
HIV
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Effects of HIV/AIDS on Nutrition• Decrease in the amount of food
consumed• Impaired nutrient absorption e.g. poor
absorption of fats and CHOs due to infection of intestinal cells by HIV, diarroheoa,O.Infections
• Changes in metabolism - infection increase nutrients requirements CHOs (10 – 15 %)s and Protein (50%+),
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Causes of DecreasedFood Consumption
• Mouth and throat sores• Loss of appetite leading to fatigue,
depression, and changes in mental state
• Side effects from medication • Abdominal pain• Household food insecurity and
poverty
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REASONS FOR GOOD NUTRITIONGood nutrition cannot cure AIDS or
prevent HIV infection, but it maintains and improve the nutritional
status of a person with HIV/AIDSdelays the progression from HIV to
AIDS-related diseases. maintains body weight and fitness.maintains and improve the
performance of the immune system reinforce the effect of the drugs
taken.
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ASSESSMENT OF NUTRITIONAL STATUS IN HIV
Why Measure? To identify and track body composition
changes over time and trends- Changes in weight- Changes in body cell mass and fat-free mass - Serum nutrient levels, cholesterol, hemoglobin etc.
To use results to design appropriate interventions
To address client concerns about their health
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What to Measure? Anthropometry Laboratory tests Clinical assessments Diet history and lifestyle
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Anthropometric Measurementsin HIV/AIDS
To assess and monitor weight Weight and height Percentage of weight and/or body mass
index changes over timeTo assess and monitor body composition
Lean body mass Body cell mass Skinfold (triceps, biceps, mid-thigh) Circumferences (waist, mid-upper arm, hips
[buttocks], mid-thigh, breast size for women, neck circumferencve (buffalo hump])
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Laboratory Measurementsin HIV/AIDS
To assess and monitor nutrient levels Serum micronutrients (e.g. retinol,
zinc) Haemoglobin (and ferritin)
To assess and monitor body composition Fasting blood sugar, Lipid profiles (e.g., cholesterol and
triglycerides) Serum insulin
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Clinical Assessments in HIV/AIDS
Symptoms and illnesses associated
with HIV/AIDS Diarrhea and vomiting Fever (temperature) Mouth and throat sores Oral thrush Muscle wasting Fatigue and lethargy Skin rashes Edema
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Diet History in HIV/AIDS24-hour food consumption or foodfrequency recalls can be used (in theabsence of acute food stress) to assess
Types and amounts of food eaten (including food access and utilization and food handling)
Use of supplements and medications Factors affecting food intake (appetite,
eating patterns, medication side effects, lifestyle, taboos, hygiene, psychological factors, stigma, economic factors)
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Stages of HIV Disease and Nutrition
Specific nutrition recommendations vary
according to underlying nutritionalstatus and HIV disease progression
Early stage: No symptoms, stable weight Middle stage: Weight loss, opportunistic
infections associated effects Late stage: Symptomatic AIDS
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Nutrition Care and Support Priorities by Stage of Disease
Asymptomatic: Counsel to stay healthy Emphasize on importance of balanced diet and increased
nutrient demand Encourage building stores of essential nutrients and
maintaining weight and lean body mass Ensure understanding of food and water safety Encourage physical activity
Middle stage – Counsel to minimize consequences Counsel to maintain dietary intake during acute illness Advise increased nutrient intake to recover and gain weight Encourage continued physical activity
Late stage: Provide comfort Advise on treating opportunistic infections Counsel to modify diet according to symptoms Encourage eating and physical activity
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Nutrition Actions for HIV-Infected People
To prevent weight loss Promote adequate energy and protein intake Individualize meal plan and modify to match
medication regime or health changes Advise changing lifestyles that negatively affect
energy and nutrient intakeTo improve body composition
Promote regular exercise to preserve muscle mass Promote steroids
To improve immunity and prevent infections Promote increased vitamin and mineral intake Promote food safety Promote use of ARVs to reduce viral load
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Promote Food Safetyto Prevent Food-Borne Illness
Educate clients to avoid products that1. Contain raw or undercooked meat2. Are displayed unsafely (e.g., mixing raw
and cooked foods or meats with fruits and vegetables)
3. Are sold in unsanitary conditions or by workers with poor personal hygiene or food handling practices
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Educate on Nutrition-Related Side Effects of ARVs
Lipodystrophy (fat maldistribution)MGT= exercises
Hyperglycemia/insulin resistanceMGT= Antioxidants (e.g., vitamin C and
selenium) to support glutathione, which is crucial in insulin action
Hyperlipidemia MGT=Decreased fat intake, Exercise,
Lifestyle changes (e.g., quitting smoking
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INFANT FEEDING IN THE CONTEXT OF HIV“When replacement feeding is
acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life” WHO,2001
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Options Exclusive breast feeding for short period - Period for breastfeeding should be decided
by the mother and fatherReplacement feeding1.Access to affordable breastmilk substitutes2.Access to facilities for hygienic preparationCounselors: Identify food security constraints
and support options to address them
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