Clinical nutrition

1. HIV Infection and Nutrition

2. Relationship between HIV and
Nutrition

3. Nutritional status and the stages of HIV

4. Important concepts
• Good nutrition is integrally linked to healthy living for
people with HIV infection
• Nutrients are required for immune system function
• Poor nutrition may accelerate HIV disease progression
• HIV disease may worsen poor nutritional status

5. Nutritional Impact of HIV
• Poor food intake
• Poor nutrient absorption
• Disruption of metabolism
• Chronic infection
• Muscle wasting or loss in lean body tissue

6. Characteristics of malnutrition related to HIV
• Weight loss.
• Muscle loss, which in late stages has been described as
‘slim disease, and eventual severe wasting.
• Progressive muscle wasting and loss of fat under the
skin giving rise to the person looking more aged than he
really is.
• Hair changes especially thinning and loss.
• Diarrhea and poor absorption of nutrients

7. Energy requirements
• Adult, HIV-Infected not showing AIDS symptoms (WHO
Stage I); Need 10% more energy or about 200-250
additional kilocalories compared to uninfected person of
the same age, sex, physical activity and physiological
state.
• Adults, HIV-Infected showing AIDS related symptoms
(WHO Stage II and above); Need 20% to 30% additional
energy depending on the severity of symptoms, which is
about 400 to 750 additional kilocalories

8. Energy requirements cont…
Children Infected with HIV;
• Need 10% more energy to maintain growth if the child is
asymptomatic.
• For children who are symptomatic but not experiencing
weight loss, the energy needs increase by about 20-30% more
per day.
• Children who are symptomatic and experiencing weight loss
need between 50% and 100% more energy per day.

9. Fat requirements
• The recommended fat intake for an HIV-infected person
is the same as for a non-HIV infected person, i.e. not
more than 30-35 percent of total energy needs.
• However, PLHIV on certain ARVs or with certain
infection symptoms, such as diarrhea, may require
changes in the timing or quantity of fat intake.

10. Critical nutritional practices
1. Have periodic nutritional status assessments, for both
symptomatic and asymptomatic clients.
2. Increase energy needs according to the disease stage.
• The additional energy can be achieved by consuming
sufficient amounts of balanced food, including one or
more snacks in the course of the day.
• Malnourished (BMI<18.5) should be supported with
supplementary food, where it is available. Severely
malnourished (BMI<16) should be treated with
appropriate therapeutic food.

11. Clinical nutritional practices
cont…
3. Maintain high levels of sanitation, food hygiene, and
food/water safety at all times.
4. Practice positive living behaviors, including safe sex,
moderate use of alcohol and cigarettes, moderate
consumption of junk foods, and managing depression
and stress.
5. Carry out physical activity or exercises to strengthen or
build muscles, and increase appetite and health.
6. Drink plenty of clean safe water (8 glasses in a day).

12. Clinical nutrition practices
cont…
7. Seek prompt treatment for all opportunistic infections
and other diseases
8. Manage the drug-food interactions and diet related side-
effects by preparing and following a drug-food schedule.
9. Children (below 6 months) born to HIV+ mothers whose
mothers/caregivers have opted for exclusive
replacement feeding, should be given multivitamin
supplements

13. Barriers to nutrition
• Factors that increase metabolic demands
– HIV infection itself
– Fever
– Acute illness

14. Barriers to nutrition
• Factors that decrease food intake
– Difficulty and pain when swallowing
– Nausea, abdominal pain
– Diarrhea
– Anorexia
– Neurologic disease/dementia

15. Barriers to nutrition
• Economic realities:
• HIV may affect ability to earn a living
• HIV may lead to loss of assets
• HIV may lead to disruption of social
networks

16. Barriers to nutrition
• Environmental realities:
• Famine
• Socio-political events
• These may prevent access to food and/ or
clean water

17. What can we do to help improve nutritional status
given these obstacles?
• Assess which patients require more extensive
nutrition management (“high risk” patients)
• Individualize nutrition care plans
• Maximize food intake during HIV/AIDS related
infections by diagnosing and treating the infection and
counseling patients about which foods to eat
• Educate patients on ARV therapy about drug-food
interactions

18. Nutritional assessment
• Weigh patient at each visit
• Record weight and body mass index (BMI) at each
visit
• Use growth curves to monitor infants and children
• Observe clinical condition
• Ask about food intake/ hunger
• Ask about specific symptoms that may prevent food
intake

19. High risk signs and symptoms
• Appetite loss
• Weight loss
• Diarrhea
• Pain when swallowing (odynophagia)
• Difficulty swallowing (dysphagia)
• Dehydration
• Clinical signs of nutrient deficiency
• Loss of muscle mass.

20. Individualize the Nutrition care plan
– Understand factors which may influence your
patients’ ability to eat a sufficient diet
– Know what foods your patient population
consumes and how the food is prepared
– Know what foods are locally available, palatable,
affordable and can be realistically incorporated
into the diet

21. Maximise food intake in acute
illness
• Use food-based symptom management
• Use locally available foods that can be easily
incorporated into the diet
• Try to provide patients with available nutrient dense
foods that help alleviate their acute symptoms

22. Maximizing food intake
• Loose bowels and diarrhea:
– Eat starchy foods such as bananas, soft rice,
porridge, maize, sorghum, potato, cassava, and
blended foods like corn-soy blend
– Protein; eggs, chicken or fish
– May need to reduce dairy products until diarrhea
subsides
– Decrease high fat foods; boil and steam instead of
frying

23. Maximising food intake -ct
• Avoid caffeine (coffee and teas) and alcohol
• Drink liquids often to avoid dehydration (soups, diluted
fruit juices, boiled water)
• Consume foods that help retain fluid such as millet,
banana, peas and lentils
• Eat fermented foods such as yogurt, sour milk etc.
• Limit gas forming foods such as cabbage, onions, soda

24. Summary
• Malnutrition can contribute to and result from
progression of HIV disease
• A nutrition action plan the includes a surveillance
system, individualized care plans, food-related symptom
management guidelines and food-drug related
information may have positive effects

25. Benefits of nutrition interventions

26. Assignment
Read about:
• Protein, vitamin and Micronutrient requirements in
people with HIV / AIDs