NUTRITIONAL ASPECTS OF HIV CARE

Nurses at the Forefront of HIV Care

18-19 March 2010Protea Court Yard Hotel

Entry points for raising nutritional issues in providing care and support

During post testing

counselingWhen

coming fortreatment

for illnesses

Duringnutrition

education

DuringCounseling for

people with clinical AIDS

Part ofvoluntary

counselingand testingprogramme

Homevisits aspart of

home careself-help groups

and supportgroups for

carers

NURSE

OutlineFood, nutrition, food groups & B.

DietWhy nutrition and HIV? R’shipAspects of nutrition that matter in

HIV/AIDS situationAssessment of nutritional statusNutritional mgt of diet related

HIV/AIDS complicationsInfant feeding options in HIV

situation

Nutrition, Food groups & Balanced Diet

Source: Adapted from RCQHC and FANTA 2003

Vicious Cycleof Malnutrition and HIV

Poor Nutrition resulting in weight loss, muscle wasting, weakness, nutrient deficiencies

Increased Nutritional needs, Reduced food intake and increased loss of nutrients

Increased vulnerability to infections e.g. Enteric infections, flu, TB hence Increased HIV replication, Hastened disease progression Increased morbidity

Impaired immune system Poor ability to fight HIV and other infections, Increased oxidative stress

HIV

Effects of HIV/AIDS on Nutrition

• Decrease in the amount of food consumed

• Impaired nutrient absorption e.g. poor absorption of fats and CHOs due to infection of intestinal cells by HIV, diarroheoa,O.Infections

• Changes in metabolism - infection increase nutrients requirements CHOs (10 – 15 %)s and Protein (50%+),

Causes of DecreasedFood Consumption

• Mouth and throat sores

• Loss of appetite leading to fatigue, depression, and changes in mental state

• Side effects from medication

• Abdominal pain

• Household food insecurity and poverty

REASONS FOR GOOD NUTRITIONGood nutrition cannot cure AIDS or

prevent HIV infection, but it maintains and improve the nutritional

status of a person with HIV/AIDSdelays the progression from HIV to

AIDS-related diseases. maintains body weight and fitness.maintains and improve the

performance of the immune system reinforce the effect of the drugs taken.

ASSESSMENT OF NUTRITIONAL STATUS IN HIV

Why Measure? To identify and track body composition

changes over time and trends- Changes in weight

- Changes in body cell mass and fat-free mass

- Serum nutrient levels, cholesterol, hemoglobin etc.

To use results to design appropriate interventions

To address client concerns about their health

What to Measure?

Anthropometry Laboratory tests Clinical assessments Diet history and lifestyle

Anthropometric Measurementsin HIV/AIDS

To assess and monitor weight Weight and height Percentage of weight and/or body mass

index changes over time

To assess and monitor body composition Lean body mass Body cell mass Skinfold (triceps, biceps, mid-thigh) Circumferences (waist, mid-upper arm, hips

[buttocks], mid-thigh, breast size for women, neck circumferencve (buffalo hump])

Laboratory Measurementsin HIV/AIDS

To assess and monitor nutrient levels Serum micronutrients (e.g. retinol,

zinc) Haemoglobin (and ferritin)

To assess and monitor body composition Fasting blood sugar, Lipid profiles (e.g., cholesterol and

triglycerides) Serum insulin

Clinical Assessments in HIV/AIDS

Symptoms and illnesses associated

with HIV/AIDS Diarrhea and vomiting Fever (temperature) Mouth and throat sores Oral thrush Muscle wasting Fatigue and lethargy Skin rashes Edema

Diet History in HIV/AIDS

24-hour food consumption or foodfrequency recalls can be used (in theabsence of acute food stress) to assess

Types and amounts of food eaten (including food access and utilization and food handling)

Use of supplements and medications

Factors affecting food intake (appetite, eating patterns, medication side effects, lifestyle, taboos, hygiene, psychological factors, stigma, economic factors)

Stages of HIV Disease and Nutrition

Specific nutrition recommendations vary

according to underlying nutritionalstatus and HIV disease progression

Early stage: No symptoms, stable weight

Middle stage: Weight loss, opportunistic infections associated effects

Late stage: Symptomatic AIDS

Nutrition Care and Support Priorities by Stage of Disease

Asymptomatic: Counsel to stay healthy Emphasize on importance of balanced diet and increased

nutrient demand Encourage building stores of essential nutrients and

maintaining weight and lean body mass Ensure understanding of food and water safety Encourage physical activity

Middle stage – Counsel to minimize consequences Counsel to maintain dietary intake during acute illness Advise increased nutrient intake to recover and gain weight Encourage continued physical activity

Late stage: Provide comfort Advise on treating opportunistic infections Counsel to modify diet according to symptoms Encourage eating and physical activity

Nutrition Actions for HIV-Infected People

To prevent weight loss Promote adequate energy and protein intake Individualize meal plan and modify to match

medication regime or health changes Advise changing lifestyles that negatively affect

energy and nutrient intake

To improve body composition Promote regular exercise to preserve muscle mass Promote steroids

To improve immunity and prevent infections Promote increased vitamin and mineral intake Promote food safety Promote use of ARVs to reduce viral load

Promote Food Safetyto Prevent Food-Borne Illness

Educate clients to avoid products that

1. Contain raw or undercooked meat

2. Are displayed unsafely (e.g., mixing raw and cooked foods or meats with fruits and vegetables)

3. Are sold in unsanitary conditions or by workers with poor personal hygiene or food handling practices

Educate on Nutrition-Related Side Effects of ARVs

Lipodystrophy (fat maldistribution)MGT= exercises

Hyperglycemia/insulin resistance

MGT= Antioxidants (e.g., vitamin C and selenium) to support glutathione, which is crucial in insulin action

Hyperlipidemia MGT=Decreased fat intake, Exercise,

Lifestyle changes (e.g., quitting smoking

INFANT FEEDING IN THE CONTEXT OF HIV“When replacement feeding is

acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life” WHO,2001

Options Exclusive breast feeding for short period - Period for breastfeeding should be decided

by the mother and fatherReplacement feeding

1.Access to affordable breastmilk substitutes

2.Access to facilities for hygienic preparation

Counselors: Identify food security constraints and support options to address them

THANK YOU FOR LISTENING !