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

2. 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

3. 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

4. Nutrition, Food groups & Balanced Diet

5. 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

6. 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%+),

7. Causes of Decreased Food Consumption
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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

8. 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.

9. 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

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

11. Anthropometric Measurements in HIV/AIDS
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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])

12. Laboratory Measurements in HIV/AIDS
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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

13. Clinical Assessments in HIV/AIDS
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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

14. 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)

15. Stages of HIV Disease and Nutrition
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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

16. Nutrition Care and Support Priorities by Stage of Disease
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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

17. Nutrition Actions for HIV-Infected People
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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

18. 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

19. 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

20. 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

21. 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

22. THANK YOU FOR LISTENING !