NUTRITIONAL ASPECTS OF HIV CARE Nurses at the Forefront of HIV Care 18-19 March 2010 Protea Court Yard Hotel

Entry points for raising nutritional issues in providing care and support During post testing counseling Part of voluntary counseling and testing programme When coming for treatment for illnesses NURSE During nutrition education During Counseling for people with clinical AIDS Home visits as part of home care self-help groups and support groups for carers

Outline Food, nutrition, food groups & B. Diet Why nutrition and HIV? R’ship Aspects of nutrition that matter in HIV/AIDS situation Assessment of nutritional status Nutritional mgt of diet related HIV/AIDS complications Infant feeding options in HIV situation

Nutrition, Food groups & Balanced Diet

Vicious Cycle of Malnutrition and HIV Nutrition and HIV PowerPoint 2 Vicious Cycle of 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 Source: Adapted from RCQHC and FANTA 2003

Effects of HIV/AIDS on Nutrition Nutrition and HIV PowerPoint 2 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 Decreased Food Consumption Nutrition and HIV PowerPoint 2 Causes of Decreased Food 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 NUTRITION Good nutrition cannot cure AIDS or prevent HIV infection, but it maintains and improve the nutritional status of a person with HIV/AIDS delays 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 Nutrition and HIV PowerPoint 3 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

Nutrition and HIV PowerPoint 3 What to Measure? Anthropometry Laboratory tests Clinical assessments Diet history and lifestyle

Anthropometric Measurements in HIV/AIDS Nutrition and HIV PowerPoint 3 Anthropometric Measurements in 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 Measurements in HIV/AIDS Nutrition and HIV PowerPoint 3 Laboratory Measurements in 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 Nutrition and HIV PowerPoint 3 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 Nutrition and HIV PowerPoint 3 Diet History in HIV/AIDS 24-hour food consumption or food frequency recalls can be used (in the absence 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 Nutrition and HIV PowerPoint 3 Stages of HIV Disease and Nutrition Specific nutrition recommendations vary according to underlying nutritional status 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 Nutrition and HIV PowerPoint 3 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 Nutrition and HIV PowerPoint 3 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 Safety to Prevent Food-Borne Illness Nutrition and HIV PowerPoint 3 Promote Food Safety to Prevent Food-Borne Illness Educate clients to avoid products that Contain raw or undercooked meat Are displayed unsafely (e.g., mixing raw and cooked foods or meats with fruits and vegetables) Are sold in unsanitary conditions or by workers with poor personal hygiene or food handling practices

Educate on Nutrition-Related Side Effects of ARVs Nutrition and HIV PowerPoint 3 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 The effects and interactions of currently used ARV therapies can compromise nutritional well being therefore affecting health care goals, recommendations and decisions. Nutritional consequences caused by use of ARV’s are either because of drug-nutrient interactions or side effects that affect intake and retention of nutrients. Numerous adverse effects of HIV therapy had been identified which have nutritional implications such as nausea, vomiting, diarhoea and changes in taste perception. Slight changes in dietary intake can help reduce these side effects and minimize weight loss. A number of new nutritional problems have been documented in HIV infected persons treated with anti-retroviral therapy but only limited data exists on strategies to mange these problems. Some of the nutrition related side effects include: lipodystrophy or fat maldistribution Hyperglycemia/Insulin resistance Hyperlidimia amongst others Treatment should include nutritional counselling

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 father Replacement 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

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