Care of Women with HIV Living in LimitedResource Settings HIV and Nutrition: Care and Support

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Care of Women with HIV Living in Limited-Resource
Settings HIV and Nutrition Care and Support

• Dorcas Lwanga, MSc, RD
• Nutrition Advisor
• Academy for Educational Development

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Objectives

• Review goals and components of nutrition care and
  support
• Discuss nutrition recommendations for the
  symptoms associated with each stage of HIV
  disease
• Provide information on how to manage
  nutrition-related symptoms of HIV

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Role of Nutrition Care and Support

• Studies have shown that the clinical outcome of
  HIV is poorer in individuals with compromised
  nutrition
• Improving nutrition can help prevent weight loss,
  strengthen the immune system and delay HIV
  disease progression.
• Nutrition care should be part of a comprehensive
  program that helps the HIV-infected individual
  and her family

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Goals of Nutrition Care and Support

• Improve nutritional status
• Maintain weight, prevent weight loss
• Preserve muscle mass
• Ensure adequate nutrient intake
• Improve eating habits and diet
• Replenish stores of essential nutrients
• Prevent food-borne illnesses
• Enhance quality of life
• Treat opportunistic infections
• Manage symptoms affecting food intake
• Provide palliative care

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Components of Nutritional Care and Support

• Nutrition assessment
• Weight
• Mid-arm circumference
• Nutrition education and counseling
• Adequate diet
• Proper food handling and safety
• Hygiene
• Water
• Sanitation

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Components of Nutritional Care and Support
continued

• Nutrition supplementation
• Food
• Vitamin and mineral supplements
• Food and nutrition support for families
• Food-for-work
• Community kitchens
• Home-based care
• Food baskets
• Home-delivered, ready to eat meals

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Stages of HIV Disease and Nutrition

• Specific nutrition recommendations vary according
  to the underlying nutritional status and extent
  of HIV disease progression
• Early - no symptoms, stable weight
• Middle - weight loss
• Late - symptomatic AIDS

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Nutrition Care and Support Priorities by Stage of
Disease

• Early stage stay healthy
• Build stores of essential nutrients
• Maintain weight and lean body mass
• Ensure understanding of food and water safety
• Middle stage minimize consequences
• Maintain dietary intake during acute illness
• Increase nutrient intake for recovery/weight gain
  
• Continue physical activity
• Late stage provide comfort
• Treat opportunistic infections
• Modify diet according to symptoms
• Encourage eating and physical activity

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Recommendations for Nutrition Care and Support
Early Stage

• Identify locally available and acceptable foods
• Promote a diet adequate in energy, protein and
  other essential nutrients
• Energy requirements are increased by 10-15
• Protein requirements are increased 50
• Requirements for vitamins and minerals used by
  the immune system are also increased
• Maintain physical activity
• Weight-bearing exercise builds lean body mass
• Exercise stimulates appetite
• Prevent food-borne illnesses through safe food
  handling practices

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Recommendations for Safe Food Handling Practices

• Wash hands before preparing and eating food,
  after using the toilet or changing nappies or
  diapers
• Wash all food preparation surfaces, utensils and
  dishes
• Wash all fruit and vegetables before eating,
  cooking or serving
• Avoid letting raw food come in contact with
  cooked food
• Cook food thoroughly
• Serve food immediately after preparation

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Recommendations For Safe Food Handling Practices
continued

• Keep food covered and away from insects, rodents
  and other animals
• Do not store cooked food
• Always use boiled or bottled water for drinking,
  cooking, and cleaning dishes and utensils
• Never use bottles with teats for feeding infants.
  Use a cup instead

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Recommendations for Nutrition Care and Support
Middle Stage

• Maintain intake during periods of acute illness
  and depressed appetite
• Increase nutrition intake to promote weight and
  muscle mass gain, and nutritional recovery
• Make every bite count
• Daily vitamin-mineral supplements
• Continue physical activity as able

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Recommendations for Nutrition Care and Support
Middle Stage continued

• Manage the symptoms that affect food intake
• Loss of appetite
• Nausea
• Mouth sores
• Diarrhea
• Seek medical attention immediately
• High fever or fever for more than 3 days
• Persistent diarrhea
• Other symptoms of infection
• Avoid unhealthy behaviors
• Alcohol, smoking and drug use
• Unsafe sexual practices

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Recommendations for Nutrition Care and Support
Late Stage

• Treat all infections that affect appetite,
  ability to eat and retention of nutrients
• Consider the food and nutritional interactions
  with medicines
• Consider the side effects of medications that
  affect intake
• Maintain intake during periods of acute illness
  and depressed appetite
• Modify diet according to symptoms
• Encourage physical activity
• Provide psychological and emotional support

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Recommendations for Symptom-Based Nutrition Care
and Support
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Recommendations for Symptom-based Nutrition Care
and Support continued
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Recommendations for Symptom-Based Nutrition Care
and Support continued
If diarrhea is severe, food may be withheld for
24 hrs or restricted to only clear fluids, such
as, soups, tea or soft foods (mashed fruit,
potatoes, white rice, porridge)
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Recommendations for Symptom-Based Nutrition Care
and Support continued
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Recommendations for Symptom-Based Nutrition Care
and Support continued
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Source of Various Vitamins and Minerals
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Source of Various Vitamins and Minerals continued
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Some Recommended Foods
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Recommendations on Foods to Avoid

• The aim of good nutrition care and support is to
  ensure adequate intake and to maintain weight and
  lean body mass. Therefore, other than the
  following, no foods should be eliminated
  unnecessarily.
• Raw eggs
• Foods that have not been thoroughly cooked,
  especially meats and chicken
• Water that is not boiled or juices that are made
  from water that is not boiled
• Alcohol and coffee
• Junk foods such as chips, biscuits and sweets
  with little nutritional value
• Foods that aggravate symptoms related to
  diarrhea, nausea/vomiting, bloating, loss of
  appetite, and mouth sores

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Nutrition and Medication

• Medications used to treat HIV opportunistic
  infections may result in negative drug-nutrient
  interactions or cause side effects.
• Vitamin B6 supplementation should be administered
  with isoniazid therapy for tuberculosis to avoid
  Vitamin B6 deficiency
• Iron and zinc-containing supplements should not
  be taken with ciproflaxacin
• Sulfadoxine and Pyrimethamine (Fansidar?) used
  for treatment of malaria is not recommended if
  the patient is folate deficient.
• Some antiretroviral drugs have
• Dietary requirements
• Side effects with nutritional consequences
• An effect on red blood cell production,
  increasing risk of anemia (e.g. Zidovudine (AZT)).

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Summary

• Maintaining adequate nutrition may be one of the
  most important things a newly infected person can
  do to prolong well-being.
• Good nutrition and healthy lifestyle can
• Preserve health
• Improve quality of life
• Prolong independence
• Delay disease progression
• Prevention of food and water-borne infections
  reduces the risk of diarrhea, a common cause of
  weight loss, malnutrition and HIV disease
  progression in people living with HIV and AIDS.

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Summary continued

• Managing common symptoms related to HIV/AIDS can
  minimize their impact on nutritional status.
• Continuing physical activity and exercise, as
  appropriate, increases energy, stimulates
  appetite and preserves and builds lean body mass.
• Providing psychosocial and emotional support as
  part of nutrition care at all stages of HIV
  disease can help to improve quality of life.
• Nutritional care and support should be part of a
  comprehensive program that deals with the needs
  of the patient and her family.