Aids/HIV information, Symptoms, treatment

1. Trace element depletion may be noticed in asymptomatic phase of disease
2. Selenium/zinc deficiency with diarrhea. Caution: Zinc supplementation may decrease immunity. Selenium deficiency may be associated with cardiomyopathy
3. B12 deficiencies

ONE study has found that high intakes of niacin, vitamin C, and thiamine were associated with slower AIDS progression and zinc associated with more rapid disease progression (Tang et al-see ref).

1. Occurs in >80% HIV patients
2. Candida albicans-most common fungus-causes anorexia/dysphagia
3. Psychological depression
4. Delayed stomach emptying-ANS effects
5. Esophageal ulcers may discourage swallowing-viral/bacterial
6. Infiltrating masses-Kaposi’s sarcoma

Total small bowel disease

1. Frequently caused by parasites.
2. 4-8 bowel movements/day. Patients will stop eating to decrease bowel movements.
3. Rx:
   • Short term parenteral nutrition
   • Next, minimal (5%) fat, lactose-free diet to stimulate gut function (Elemental enteral diet);
   • Monitor serum albumin; adjust nitrogen

Partial small bowel disease

1. Intermittent diarrhea
2. Fluid, electrolyte, B12 losses
3. Sometimes only terminal ileum involved like Crohn’s disease
4. Rx:
   • Small, frequent feedings
   • Low fat, low lactose, caffeine-free
   • Elemental diet may be needed if steatorrhea present

Large bowel disease

1. Generalized inflammatory disorder
2. Causes rapid wasting, when chronic
3. Eating avoidance common
4. May be caused by virus, bacteria, parasite or neoplasm
5. Rx:
   • Small, frequent feedings
   • Low in fiber, residue, lactose, fat, caffeine-to reduce bowel movements

1. Occurs to some degree in every patient
2. Greatly diminished quality of life
3. CDC criterion-involuntary weight loss >10%

Causes of malnutrition

1. Altered nutrient intake
   • Anorexia
   • Dysphagia
   • Depression
2. Malabsorption-diarrhea, gas, bloating
   • Enteric pathogens
   • Abnormal GI motility
   • Autonomic dysfunction
   • Bacterial overgrowth
   • 1/2 treated for diarrhea don’t respond
   • Most intestinal injury and dysfunction caused by complicating infections rather than from AIDS directly.
3. Metabolic changes due to infection
   • Abnormal lipid/protein metabolism
   • Increase in gluconeogenesis

Introduction

Nutrition may be a cofactor in HIV progression.

1)  Poor nutritional status and infection affect the immune system and interact with each other.

2) Development of opportunistic infection and malignancies.

 Malnutrition is a very serious problem in AIDS, since the timing of death is directly related to the degree of body mass depletion and is independent of the underlying cause of wasting.When wasting of lean body mass approaches 55% of normal, death is imminent. This occurs independently of the reason for weight loss.“Slim Disease” - Earliest cases in Uganda, in late 1970s, characterized by unexplained wasting.In AIDS, CACHEXIA is present. There is a loss in lean body mass. Superimposed on this may be starvation, a loss of body fat mass. 

Malnutrition Causes Infections

 Protein-calorie malnutrition (PCM) causes depression of cellular immunity with abnormal T cell and macrophage function. This could theoretically worsen the immunodeficiency of people with AIDS, making them more susceptible to infection and worsening existing infections. Virulence may be influenced by a host’s nutritional state. Malnutrition may contribute to life-threatening infectious disease.  

Infection Causes Malnutrition

1) Alters absorption and availability of nutrients

2) Alters hormone secretion, liver synthesis of acute-phase reactant proteins

3) Increases gluconeogenesis/lipogenesis

4)Most infections alter carbohydrate, lipid and protein metabolism, electrolyte balance, trace mineral/vitamin levels

 5) Fever increases caloric requirements. Each degree rise increases caloric needs by 7%.