Nutrition and HIV

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Nutrition and HIV

• LCDR Susan Jones
• Registered Dietitian

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Introduction

• Optimizing Nutritional Status with HIV
• Many HIV/AIDS related complications can be
  avoided and/or prolonged through good nutrition
  habits
• Improved nutritional status can be successfully
  accomplished by making better choices based on
  improved knowledge of proper nutrition

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Agenda

• Nutritional Status as it relates to HIV
• The benefits to be derived from Optimal Nutrition
  
• Timely Education and Intervention
• Nutrition Education and Wise Food Choices

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Overview

• If you are a person living with HIV/AIDS, proper
  nutrition is extremely important.
• The vitamins, minerals and energy you receive
  from food, along with advice from your medical
  team about different nutritional supplements, may
  help to minimize the complications of HIV disease.

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Nutrition and HIV

• When you make nutrition a priority each day,
  the benefits may include feeling and looking
  better and staying healthier longer.
• Eating enough of the foods you need can be
  challenging, since HIV/AIDS adds stresses that
  change your usual nutrient needs.

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Benefits of Optimal Nutrition

• Increased Energy Level
• Improved Productivity
• Improved Sense of Well-Being
• Improved Body Weight
• Muscle Strength
• Overall, Healthier Mind and Body
• Improved Immune Defenses
• Enhances Disease Fighting Tactics for
  HIV/AIDS-related complications, including fever,
  weight loss, and muscle wasting.all of which can
  be accelerated by poor nutrition habits

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Timely Education and Intervention

• Early nutrition education and intervention can
  decrease or delay hospitalizations, emergency
  room visits and generally improve and/or prolong
  the quality of life
• Early identification of nutritional problems is
  vital to successful prevention and treatment to
  prevent the loss of crucial body tissues, such as
  early indicators of malnutrition, food drug
  interactions, altered appetites, lab values, etc.
  as they relate to overall good nutrition(5
  unintentional weight loss 1-6months red flag).

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Nutrition Education

• Three or more meals and snacks each day can
  provide the nutrients needed to build a strong
  immune system.
• These nutrients include proteins, carbohydrates,
  fats, vitamins, minerals and WATER.
• In addition, food keeps the digestive tract
  working. Because the digestive tract plays an
  important role in building a strong immune
  system, the act of eating is a disease-fighting
  mechanism

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Modern Nutritional Care Plan
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Modern HIV Nutrition Guidelines

• 35-45 calories per day per kilogram of body wt
• 1.2-2.0grams of protein per day per kg of body wt
• Follow heart healthy guidelines

• Consume high quality protein (e.g.lean meats,
  poultry, fish, eggs, beans, low fat dairy, soy
  protein)
• Four to six small frequent meals/snacks per day

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Modern HIV Nutrition Guidelines

• Consume complex carbohydrates high in fiber-
  whole grains, unrefined products-oatmeal, brown
  rice, whole wheat pasta, at least 5-9
  fruits/vegetables daily

• Replace saturated fats with monounsaturated (e.g.
  olive oil, fatty fish, flax seed oil, avocados,
  nuts)
• Recommend fish 2x/wk to increase intake of
  omega-3 fatty acids

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Increased risk for loss of bone density

• Stop smoking!
• Reduce ETOH consumption
• Adequate calcium intake 1200mg/day (3-4
  servings)
• Regular exercise

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Food Water Safety

• Make sure eggs are well cooked. Avoid sunny-side
  up.
• Make sure meats are well-cooked. Juices should
  run clear.
• Boiled tap water? Bottled/filtered water best
  choice.
• Avoid soft ripened cheese(blue, brie)

• Wash hands for at least 20 seconds before and
  after preparing foods
• Cook and reheat foods 140degrees
• Throw out leftovers after 2 days (if in doubt
  throw it out!)

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Food/Drug Interactions- Take without regard to
foods

• Epivir (3TC)
• Retrovir (AZT)
• Combivir (AZT 3TC in one)
• Zerit (d4T)
• Hivid (ddC)
• Ziagen (abacavir)
• Rescriptor (delavirdine)
• Viramune (nevirapine)

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Food/Drug Interactions

• Take on an empty stomach
• Crixivan (indinivir)-(except if RXd with Norvir,
  it can be taken without regard to foods)
• Videx (ddl EC)
• Avoid high-fat meal
• Agenerase (amprenavir)
• Sustiva (efavirenz)

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Medication Side-Effect Management

• Nausea/Vomiting
• Diarrhea
• Poor Appetite
• Dysphagia
• Taste Changes

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Key Nutrients in HIV

• Selenium- 200mcg daily
• Vitamin B12
• Vitamin A- DV 5000IU to UTL10,000IU
• Vitamin C 1000mg
• Vitamin E 800 IU
• Glutamine 0.5g/kg of actual wt- helps increase
  lean muscle mass/wt gain
• Arginine- stimulates protein synthesis, enhances
  wound healing and immune function (product
  Arginaid)

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Oral Nutritional Supplements

• Who needs nutritional supplements? BMI CD4 cell count
• Need to meet with dietitian for individualized
  treatment
• Used most effectively when they supplement meals
  rather than replace meals
• Supplements are NO excuse for poor dietary habits
• Dietitian can provide recipes for high
  calorie/high protein shake ideas

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Supplement Examples

• Ensure with Fiber 1.1 grams Nutra Flora, 3
  grams fiber
• Boost with Fiber comparable no Nutra Flora
• Advera high-calorie, high-protein, fiber
  fortified(fortified with Vit E, C, B6, B12 folic
  acid, and omega 3 fa)
• Nutrivir or Nutrivir NSA(no sugar added)-
  complete vanilla flavored supplement with
  therapeutic amounts of vitamins, minerals, and
  antioxidants.
• Impact Recover 240kcal, 4 grams arginine, 5
  grams of glutamine, 420 mg n-3 FA
• JUVEN- 3 grams HMB, 14gm L-arginine, 14 gm
  L-glutamine

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Where to Get More Information

• Registered Dietitian
• Health Care Team
• Credentialed Internet Sites

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Summary

• State what has been learned
• Questions/comments
• Request feedback of training session