HIV/AIDS and Nutrition Jeanne Garber MS,RD,LN Yellowstone City-County Health Department
HIV and Aids 2002 World United States Living with HIV or Aids42,000, ,000 Newly infected with HIV 5,000,000 40,000 Aids Deaths 3,100,000 14,500
Bringing a new perspective to the international AIDS crisis. 37,800,000 people living with HIV/AIDS globally at the end of ,000,000 people who travel to Las Vegas every year 26,900,000 people living with AIDS in developing countries 27,000,000 people reached by Yahoo News and Google News 4,800,000 new infections globally in 2003: 4,900,000 Americans who had non-surgical cosmetic procedures in ,900,000 people globally who died of AIDS in ,200,000 people in SubSaharan Africa who died of AIDS in ,144,000 women living with HIV/AIDS globally 18,000,000 Americans living with diabetes
14,250,000: women living with HIV/AIDS in sub-Saharan Africa 200,000: women living with HIV/AIDS in North America 12,000,000: (Estimated) children in SubSaharan Africa who have lost one or both parents to AIDS 18,400,000: children worldwide expected to have lost parents to HIV/AIDS by ,000,000: people in SubSaharan Africa living with HIV/AIDS at the end of ,400,000: Asians living with HIV/AIDS at the end of ,300,000: people in Eastern Europe and Central Asia living with HIV/AIDS 950,000: people living with AIDS in the United States
Classification HIV positive is when a person is infected with the virus AIDS: CD4 cells less than 500 with an opportunistic disease.
Nutritional risk HIV-infected patients may be at nutritional risk at any point in their illness –Delayed weight gain in children –Weight loss –Loss of lean tissue –Severe malnutrition –Developing fat-redistribution syndrome –Diabetes heart disease and stroke
Nutrition Education Healthful dietary principles Maintain lean body mass Drug therapies Drug/nutrient interactions Gastrointestinal interactions Herbal and/or nutritional supplements Exercise Substance Abuse Food Safety
Healthful Dietary Principles Healthy lifestyle changes. 5-9 fruits and vegetables. Increasing fiber Limit fat to 30 % of total calories Exercise
Lean Body Mass Height Weight: usual, current, and ideal Triceps Skin Fold BMI Bioelectric Impedance Analysis (BIA)
Drug Therapies Three types of drug therapies 1.Nucleoside Reverse Transcriptase Inhibitors 2.Non-nucleoside Reverse Transcriptase Inhibitors 3.Protease Inhibitors
Food/Drug Interactions Calorie, protein and fat recommendations Barriers and solutions to meeting food requirements for medications Antacids
Herbal Products Cat’s claw, chamomile, echinacea, goldenseal inhibition of CYP3A4 St. John’s wort decreases levels of indinavir and cyclosporine Ginkgo, Dong quai, and ginseng increases INR when combined with warfarin Ephedra: toxicity when combined with caffeine and other stimulants Glucosamine: decreased glucose tolerance
Supplements General recommendations Multivitamin w/o extra iron Vitamin E if taking drugs toxic to the bone marrow. Not for anyone taking Agenerase Correct Vit. A deficiencies can increase CD4 counts. Best to do so by food. Vit B 12 associated with dementia, neuropathy, and are at risk due to diarrhea. Vit. B complex take 2 times daily
Supplementation Vit. C: in smokers with ppd hx > 15 years 500mg bid. Not more than 3g/day Alcohol: Vit.A, B12, B-complex and thiamine deficiencies. Also nutrient deficient due to poor diet. Substance abuse: Zinc, Vit. C, Vit A- through diet. Assess dietary intake.
GI interactions Many meds particularly protease inhibitors, cause diarrhea Nausea/vomiting can occur when starting HAART meds, or w/o adequate food GERD: triggered by caffeine, alcohol, citrus, tomatoes, mint, garlic and onions
Diet and Exercise Reduce lipodystrophy Reduce triglyceride levels Reduces other side effects due to HIV medications
Substance Abuse Poor food intake Zinc deficiency Low levels of vitamins A, C and E
Food Safety Food and waterborne diseases Diarrhea Enteric Infections Salmonellosis Listeriosis Vibro vulnificus: Oysters, shellfish