Nutritional Implications of HIVAIDS

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Nutritional Implications of HIV/AIDS

• Presented by
• Sharmaine E. Edwards
• Director, Nutrition Services
• Ministry of Health, Jamaica
• 2006 March 29

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Outline

• Causes and manifestations of malnutrition in
  HIV/AIDS
• Nutrition screening

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Outline

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

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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

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Link Between Malnutrition and HIV
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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
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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

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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

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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

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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

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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

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Causes of MalnutritionOther Factors

• Special needs groups
• pregnancy, lactation, childhood
• Socioeconomic factors
• Poverty, homelessness
• Illicit drug use

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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

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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

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Manifestations of Malnutrition Wasting

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

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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

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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)

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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

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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

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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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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

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