HIV and AIDS

HIV/AIDS HIV - virus that targets host immune cells and turns them into viral factories for HIV reproduction AIDS - associated symptomatic condition rendering the host vulnerable to opportunistic infections, disability, death

Nutrition Therapy Nutritional Implications AIDS-related wasting syndrome (AWS) Changes in body composition during weight loss like starvation or marasmus Weight loss or wasting even with adequate or increased kcal intake, may be immune mediated Decrease in LBM even without weight loss Goal: maintain or restore nutritional status Weight maintenance Inflammatory state: breaks down protein stores  wasting

Nutrition Therapy Nutritional Implications Reduction in muscular protein influenced by medications Calories, protein Changes in macro- and micronutrient status Lower serum selenium, zinc, magnesium, calcium, iron, manganese, copper, carotene, choline, glutathione, vitamins A, B6, B12, E Carnotene: helps process fats/lipids

Nutrition Therapy Nutritional Assessment Nutritional risk screening and follow-up assessment for identified risk factors Physical, biochemical, nutrition-related factors, social factors

Nutrition Therapy Nutritional Assessment Physical BMI less than 20 we would start looking at parentral nutrition Weight Body composition Assess causes of weight loss and body composition changes without weight loss Total volumes of body compartments and patterning of fat tissue CT scan, underwater weight, fat folds, bioelectric competence

Abdominal circumference © 2007 Thomson - Wadsworth

Abdominal skinfold

Right side skinfold © 2007 Thomson - Wadsworth

Back skinfold © 2007 Thomson - Wadsworth

Infraorbital skinfold © 2007 Thomson - Wadsworth

Buccal skinfold © 2007 Thomson - Wadsworth

Sub-mandibal skinfold © 2007 Thomson - Wadsworth

Nutrition Therapy Biochemical Assessment Viral load CD4 count CRP Albumin Concerned about protein Liver function tests Medications effect their liver Look at stage they’re in Renal function tests Insulin, blood sugar Hormone levels

Nutrition Therapy Medical History Assessment Current and past medical conditions Hx of nutrition problems Concomitant diseases Use of herbal and OTC meds Potential drug-nutrient interactions

Nutrition Therapy Dietary Evaluation Food behaviors Food security Food intake Compare with estimated needs for fluids, protein, micronutrients Need for food and nutrient supplements

Nutrition Therapy Nutrition Interventions Macronutrient Therapy Fluid based on hydration maintenance Kcal based on balance for healthy weight Protein recommendations usually higher

© 2007 Thomson - Wadsworth

Nutrition Therapy Symptom management Fatigue and diarrhea most common Anti-diarrheals Pancreatic or lactase enzymes Supplementation of nutrients as pharmaceutical agents