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Nutritional Implications of HIVAIDS

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Nutritional problems are common and may be experienced in clusters ... Nutrition screening identifies individuals in need of more in depth nutritional care ... – PowerPoint PPT presentation

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Title: Nutritional Implications of HIVAIDS


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
  • Nutrition screening

3
Outline
  • Causes and manifestations of malnutrition in
    HIV/AIDS
  • Managing Nutrition and Food-related Problems
  • Antiretroviral Medications and Food-Drug
    Interactions

4
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

5
Link Between Malnutrition and HIV
6
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
7
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

8
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

9
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

10
Causes of MalnutritionIncreased Requirements
  • 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

11
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

12
Causes of MalnutritionOther Factors
  • Special needs groups
  • pregnancy, lactation, childhood
  • Socioeconomic factors
  • Poverty, homelessness
  • Illicit drug use

13
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

14
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

15
Manifestations of Malnutrition Wasting
  • Diverse clinical presentation
  • Maladaptive response to reduced intake
  • Progressive loss of body cell mass
  • Lipoatrophy associated with lipodystrophy

16
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

17
HIV-Associated Wasting
  • Wasting Syndrome
  • 10 weight loss in context of diarrhea/fever
  • Proposed definition for HIV-Wasting
  • gt10 loss in 6 months
  • gt5 loss in 3 months
  • gt 3 loss in 1 month
  • BMI lt 20
  • loss of 5 Body Cell Mass
  • (m) BCM lt 35 total weight (BMI lt27)
  • (f) BCM lt 23 total weight (BMI lt 27)

18
Manifestations of MalnutritionMicronutrient
Deficiencies
  • Common, especially in persons with CD4 lt 200
  • Due to
  • Inadequate dietary intake
  • Malabsorption
  • Increased turnover
  • Metabolic abnormalities
  • Associated with increased mortality and faster
    disease progression

19
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

20
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

21
Exercise
  • Handouts of 3 tools
  • Determine which tool if any would be most useful
    in your setting
  • Who will administer the tool
  • How will referrals be made
  • On what basis
  • To whom
  • Who will refer

22
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