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Nutritional Implications of HIV/AIDS

Nutritional Implications of HIV/AIDS. Presented by Sharmaine E. Edwards Director, Nutrition Services Ministry of Health, Jamaica 2006 March 29. Outline. Causes and manifestations of malnutrition in HIV/AIDS Managing Nutrition and Food-related Problems

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Nutritional Implications of HIV/AIDS

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  1. Nutritional Implications of HIV/AIDS Presented by Sharmaine E. Edwards Director, Nutrition Services Ministry of Health, Jamaica 2006 March 29

  2. Outline • Causes and manifestations of malnutrition in HIV/AIDS • Managing Nutrition and Food-related Problems • Antiretroviral Medications and Food-Drug Interactions

  3. Introduction • Nutritional problems are prevalent • Complex, multi-factorial etiology • Negative impact on immunity & overall health • Decreased quality of life and ability to perform activities of daily living • Increased health care costs

  4. Link Between Malnutrition & HIV/AIDS Malnutrition Wasting Increased requirements Decreased Intake Increased losses Decreased Immunity HIV Opportunistic Infections Increased risk of mortality Disease progression to AIDS

  5. Malnutrition in HIV/AIDS • Starvation • inadequate energy intake or malabsorption • adaptation to conserve energy and protein • responds to refeeding • Cachexia • sepsis, trauma, neoplasm • increased metabolic rate and hypercatabolism of somatic protein • treat infection to improve response to feeding

  6. Causes of MalnutritionInadequate Dietary Intake • Loss of appetite • Gastrointestinal complications • Nausea • Early satiety • Delayed gastric emptying • Oral/esophageal complications • Herpes, Candidiasis, CMV • Abnormal taste, dental problems • Eating disorders

  7. Causes of MalnutritionIncreased Nutrient Losses • Diarrhoea • Side effect of medications • Opportunistic infections • HIV enteropathy • Malabsorption • Carbohydrates, protein, fats, micronutrients, electrolytes • Possible in asymptomatic individuals • Vomiting • Opportunistic infections • Side effects of medications • Sweats • Lose electrolytes and fluids

  8. Energy Elevated with high viral load, opportunistic infection and need to gain weight, activity Protein Elevated for immune cell replication, maintenance of lean body mass, during periods of opportunistic infection Micronutrients Elevated to treat deficiencies and may have a role in preventative therapy Causes of MalnutritionIncreased Requirements

  9. Causes of MalnutritionOther Factors • Metabolic abnormalities • Drug-food interactions and side effects • Nausea, stomach ache, & early satiety • Diarrhea, bloating, malabsorption • Neuropathy and limited mobility • Co-morbidities

  10. Causes of MalnutritionOther Factors • Special needs groups • pregnancy, lactation, childhood • Socioeconomic factors • Poverty, homelessness • Illicit drug use

  11. Manifestations of MalnutritionWeight Loss Lose adipose and lean tissue • Typical pattern 60% adipose, 40% lean • Acute or rapid weight loss is linked to opportunistic infections • Chronic or slow weight loss is linked to gastrointestinal disease or high viral load

  12. Implications of Weight Loss • 3% change = normal variation • 5% unintentional loss = risk for wasting, mortality, opportunistic infections • 10% loss = wasting syndrome • 20% loss with OI = hospitalization

  13. Manifestations of Malnutrition Wasting • Diverse clinical presentation • Maladaptive response to reduced intake • Progressive loss of body cell mass • Lipoatrophy associated with lipodystrophy

  14. Wasting due to systemic inflammatory response • Neuroendocrine mediation: catecholamines glucagon, growth hormone, corticosterone • mobilize glucose, fatty acids, amino acids • Cytokine production • anorexia & semi-starvation • decreased muscle protein synthesis • increased muscle protein catabolism

  15. HIV-Associated Wasting Wasting Syndrome • 10% weight loss in context of diarrhea/fever Proposed definition for HIV-Wasting • >10% loss in 6 months • >5% loss in 3 months • > 3% loss in 1 month • BMI < 20 • loss of 5% Body Cell Mass • (m) BCM < 35% total weight (BMI <27) • (f) BCM < 23% total weight (BMI < 27)

  16. Manifestations of MalnutritionMicronutrient Deficiencies • Common, especially in persons with CD4 < 200 • Due to • Inadequate dietary intake • Malabsorption • Increased turnover • Metabolic abnormalities • Associated with increased mortality and faster disease progression

  17. Identify Nutritional Risk Methods include • Nutrition screening • Classification of risk by category • Subjective global assessment Need to identify method, who will screen, and referral process

  18. Conclusion • Nutritional problems are common and may be experienced in clusters • The etiology of malnutrition is complex • Nutrition screening identifies individuals in need of more in depth nutritional care

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