1. HIV/AIDS and Nutrition Jeanne Garber MS,RD,LN Yellowstone City-County Health Department

2. HIV and Aids 2002 World United States Living with HIV or Aids42,000,000 850,000 Newly infected with HIV 5,000,000 40,000 Aids Deaths 3,100,000 14,500

3. Bringing a new perspective to the international AIDS crisis. 37,800,000 people living with HIV/AIDS globally at the end of 2003 35,000,000 people who travel to Las Vegas every year 26,900,000 people living with AIDS in developing countries 27,000,000 people reached by Yahoo News and Google News 4,800,000 new infections globally in 2003: 4,900,000 Americans who had non-surgical cosmetic procedures in 2002 2,900,000 people globally who died of AIDS in 2003 2,200,000 people in SubSaharan Africa who died of AIDS in 2003 18,144,000 women living with HIV/AIDS globally 18,000,000 Americans living with diabetes

4. 14,250,000: women living with HIV/AIDS in sub-Saharan Africa 200,000: women living with HIV/AIDS in North America 12,000,000: (Estimated) children in SubSaharan Africa who have lost one or both parents to AIDS 18,400,000: children worldwide expected to have lost parents to HIV/AIDS by 2010 25,000,000: people in SubSaharan Africa living with HIV/AIDS at the end of 2003 7,400,000: Asians living with HIV/AIDS at the end of 2003 1,300,000: people in Eastern Europe and Central Asia living with HIV/AIDS 950,000: people living with AIDS in the United States

5. Classification HIV positive is when a person is infected with the virus AIDS: CD4 cells less than 500 with an opportunistic disease.

6. Nutritional risk HIV-infected patients may be at nutritional risk at any point in their illness –Delayed weight gain in children –Weight loss –Loss of lean tissue –Severe malnutrition –Developing fat-redistribution syndrome –Diabetes heart disease and stroke

7. Nutrition Education  Healthful dietary principles  Maintain lean body mass  Drug therapies  Drug/nutrient interactions  Gastrointestinal interactions  Herbal and/or nutritional supplements  Exercise  Substance Abuse  Food Safety

8. Healthful Dietary Principles  Healthy lifestyle changes.  5-9 fruits and vegetables.  Increasing fiber  Limit fat to 30 % of total calories  Exercise

9. Lean Body Mass  Height  Weight: usual, current, and ideal  Triceps Skin Fold  BMI  Bioelectric Impedance Analysis (BIA)

10. Drug Therapies  Three types of drug therapies 1.Nucleoside Reverse Transcriptase Inhibitors 2.Non-nucleoside Reverse Transcriptase Inhibitors 3.Protease Inhibitors

11. Food/Drug Interactions  Calorie, protein and fat recommendations  Barriers and solutions to meeting food requirements for medications  Antacids

12. Herbal Products  Cat’s claw, chamomile, echinacea, goldenseal inhibition of CYP3A4  St. John’s wort decreases levels of indinavir and cyclosporine  Ginkgo, Dong quai, and ginseng increases INR when combined with warfarin  Ephedra: toxicity when combined with caffeine and other stimulants  Glucosamine: decreased glucose tolerance

13. Supplements  General recommendations  Multivitamin w/o extra iron  Vitamin E if taking drugs toxic to the bone marrow. Not for anyone taking Agenerase  Correct Vit. A deficiencies can increase CD4 counts. Best to do so by food.  Vit B 12 associated with dementia, neuropathy, and are at risk due to diarrhea.  Vit. B complex take 2 times daily

14. Supplementation  Vit. C: in smokers with ppd hx > 15 years 500mg bid. Not more than 3g/day  Alcohol: Vit.A, B12, B-complex and thiamine deficiencies. Also nutrient deficient due to poor diet.  Substance abuse: Zinc, Vit. C, Vit A- through diet. Assess dietary intake.

15. GI interactions  Many meds particularly protease inhibitors, cause diarrhea  Nausea/vomiting can occur when starting HAART meds, or w/o adequate food  GERD: triggered by caffeine, alcohol, citrus, tomatoes, mint, garlic and onions

16. Diet and Exercise  Reduce lipodystrophy  Reduce triglyceride levels  Reduces other side effects due to HIV medications

17. Substance Abuse  Poor food intake  Zinc deficiency  Low levels of vitamins A, C and E

18. Food Safety  Food and waterborne diseases  Diarrhea  Enteric Infections  Salmonellosis  Listeriosis  Vibro vulnificus: Oysters, shellfish