Session 3: Nutrition and HIV Medications Nutrition Management with HIV and AIDS: Practical Tools for...
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Transcript of Session 3: Nutrition and HIV Medications Nutrition Management with HIV and AIDS: Practical Tools for...
Session 3:Session 3:Nutrition and HIV MedicationsNutrition and HIV Medications
Nutrition Management with HIV and AIDS: Practical Tools for Health Workers
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 2
ObjectivesObjectives
• Explain the importance of nutrition and HAART
• Identify food effect or potential side effect for each antiretroviral medication
• Counsel clients on food effects of medications by using the food-medication timetable
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 3
Why is Nutrition Important Why is Nutrition Important with Medications?with Medications?
• Improved treatment effectiveness and efficiency
• Prevention of side effects
• Better adherence, means less resistance
• Improved quality of life
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 4
Effects of Malnutrition and HIV on the Effects of Malnutrition and HIV on the Immune SystemImmune System
CD4 T-lymphocyte number
CD8 T-lymphocyte number
Skin sensitivity to infections
CD4 / CD8 ratio
Serologic response after immunizations
Bacteria killing
Good Nutrition
HAART
Malnutrition HIV
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 5
ARV vs. HAARTARV vs. HAART
• ARV:ARV: antiretroviral medication refers to the individual medications that are used to inhibit the multiplication of retroviruses like HIV
• HAART:HAART: highly active antiretroviral therapy refers to the treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and progress of HIV disease
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 6
Modern (New) TherapiesModern (New) Therapies
• HAART: combination of 3 or more of the following:• Non-nucleoside reverse transcriptase inhibitors
(NNRTIs)• Nucleoside reverse transcriptase inhibitors (NRTIs)• Protease Inhibitors (PIs)
• Therapies to treat opportunistic infections• Ex: TB treatment, antifungal, antibiotics
• Malaria treatment• Multivitamin/mineral supplements
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 7
Traditional TherapiesTraditional Therapies
• Herbal remedies, teas/infusion, or high-dose vitamin supplements
• Caution: some may interact with other medicines or foods• Ex: Avoid garlic supplements with Saquinavir
• Some therapies may be expensive, replace food, and can cause liver damage (especially if combined with other medications)• Always ask clients what traditional therapies they are
taking
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 8
Food and Medication InteractionsFood and Medication Interactions
• Food (affects) Medication absorption, metabolism, distribution, and excretion
• Medication (affects) Nutrient absorption, metabolism, distribution, and excretion
• Medications’ (affects) Food intake side effects and nutrient absorption
• Medications + (causes) Unhealthy side effectscertain foods or therapies
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 9
How Can Diet Help with Medications?How Can Diet Help with Medications?
• Management of side effects
• Enhance flavour of foods
• Balanced meals help prevent side effects and promote adherence
• Avoid alcohol use with medications
• Address food security issues with client
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 10
Pregnant and Lactating WomenPregnant and Lactating Women
• More food needed during pregnancy and lactation
• Good nutrition status increases effectiveness of HAART/medications and reduces infant low birth weight
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 11
Infants and Children on HAARTInfants and Children on HAART
• Increased nutrition/energy needs
• Greater risk for malnutrition, morbidity (illness) and mortality (death)
• Closely monitor growth (weight and height), clinical signs of malnutrition (i.e. wasting, oedema) and feeding patterns
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 12
Common Side Effects from MedicinesCommon Side Effects from Medicines
• Nausea, vomiting, diarrhoea
• Poor appetite
• Changes in taste
• Metabolic Changes
• Iron Deficiency Anaemia
• Liver toxicity
• Rash/skin problems
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 13
Metabolic ChangesMetabolic Changes
• Lipodystrophy: changes in the way the body makes, uses and stores fat. Two types:• Lipoatrophy: loss of subcutaneous fat (fat under the
skin), mostly in arms, legs, buttocks, and face• Lipohypertrophy: fat accumulation, mostly around the
abdomen, chest, and behind the neck
• Biochemical changes: high blood fat levels, high blood sugar levels• Increases risk of heart disease and diabetes
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 14
Metabolic ChangesMetabolic Changes
• Associated ARVs• d4T (stavudine)• Possibly other NRTIs• Protease inhibitors and
boosted PIs• Early prevention, detection,
and treatment are important! • Look for physical signs of
lipodystrophy/lipoatrophy• Biochemical monitoring C. Steinberg © ITECH, 2006
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 15“Buffalo hump” in HAART-treated patient
Dorsocervical Fat Pad Dorsocervical Fat Pad
Source: Dominic C. Chow, MD, University of Hawaii; Larry J. Day, MD, University of Michigan; Cecilia M. Shikuma, MD, University of Hawaii
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 16
Central Fat AccumulationCentral Fat Accumulation
Visceral fat accumulation, before ART
Visceral fat accumulation, four months after starting ART
Courtesy of Dr. Stefan Mauss
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 17
Dietary Considerations forDietary Considerations forMetabolic ChangesMetabolic Changes
• Reduce refined starches (e.g. maize, white bread, pastas, sugar)
• Increase fibre from whole grains (e.g. oats, mahangu, brown bread) and fresh fruits and vegetables
• Eat more “good fats” from foods like oils, avocado, and nuts and less “bad fats” from butter and deep fried foods
• Exercise at least 45 minutes a day
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 18
Counselling Pre-HAARTCounselling Pre-HAART
• What are client’s eating habits?• Number of meals per day?• What are common foods eaten?• Any times when food is not available?• Any recent weight loss? How much?• Any current medications (consider modern and
traditional medicines)?• What are specific food-medication interactions or
common side effects of proposed ART regimen?
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 19
Counselling During HAARTCounselling During HAART
• What is the client’s food-HAART schedule?• What side effects does the client have?• Has the client lost weight since beginning
HAART?• Is the client taking other medications or
traditional therapies?• If traditional therapies taken: in what form (pill),
what is cost, and do these replace meals?
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 20
Weight Gain on Effective HAART Weight Gain on Effective HAART and Nutrition Therapyand Nutrition Therapy
Photograph by: David Walton Copyright 2003 Partners In Health
Before HAART After 1 year on HAART
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 21
Common HAART RegimensCommon HAART Regimens
• AZT/3TC/NVP (zidovudine – lamivudine – nevirapine)
• AZT/3TC/EFV (zidovudine – lamivudine – efavirenz)
• AZT/ddI/INV+r (zidovudine – didanosine – indinavir+ritonavir)
• AZT/ddI/LPV+r (zidovudine – didanosine – kaletra)
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 22
Sample Adult HAART Schedule Sample Adult HAART Schedule with Meal Planwith Meal PlanTime of Day Food Medication
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 23
Food and Medication Table ActivityFood and Medication Table Activity
• Questions to answer:1. Is the diet adequate for the medication
regimen this person is taking?
2. What should be changed, if anything?
3. What are some side effects with the medications?
4. What can you tell the client to do to prevent or manage potential side effects?
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 24
Case StudiesCase Studies
Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training
Slide 25
Key PointsKey Points
1. All persons need to have access to healthy food, especially those on HIV medications
2. Counsel clients on food effects of their medications
3. Help clients make a food-medication timetable
4. HIV medications can help a person with HIV live longer, but not without proper nutrition