HIVAIDS and Nutrition

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HIV/AIDS and Nutrition

• Jeanne Garber
• MS,RD,LN
• Yellowstone City-County Health Department

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HIV and Aids 2002
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• 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

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• 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

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Classification

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

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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

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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

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Healthful Dietary Principles

• Healthy lifestyle changes.
• 5-9 fruits and vegetables.
• Increasing fiber
• Limit fat to 30 of total calories
• Exercise

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Lean Body Mass

• Height
• Weight usual, current, and ideal
• Triceps Skin Fold
• BMI
• Bioelectric Impedance Analysis (BIA)

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Drug Therapies

• Three types of drug therapies
• Nucleoside Reverse Transcriptase Inhibitors
• Non-nucleoside Reverse Transcriptase Inhibitors
• Protease Inhibitors

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Food/Drug Interactions

• Calorie, protein and fat recommendations
• Barriers and solutions to meeting food
  requirements for medications
• Antacids

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Herbal Products

• Cats claw, chamomile, echinacea, goldenseal
  inhibition of CYP3A4
• St. Johns 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

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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

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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.

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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

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Diet and Exercise

• Reduce lipodystrophy
• Reduce triglyceride levels
• Reduces other side effects due to HIV medications

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Substance Abuse

• Poor food intake
• Zinc deficiency
• Low levels of vitamins A, C and E

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Food Safety

• Food and waterborne diseases
• Diarrhea
• Enteric Infections
• Salmonellosis
• Listeriosis
• Vibro vulnificus Oysters, shellfish