Aids/HIV information, Symptoms, treatment

Food scrimping to pay for medicines, health insurance.

 - May live in apartment or motel with no kitchen.

 - May be too weak to shop.

- Feelings of isolation.

- Depression/anxiety

Food Quackery and AIDS “Alternative” therapies

1. Dr. Berger’s Immune Power Diet
2. Yeast-free diets
3. Macrobiotic diets-yin/yang
4. Vitamin megadosing
5. Cleansing rituals-fasting/enemas

Goals

• Preserve lean body mass
• Provide adequate levels of nutrients
• Minimize malabsorption symptoms

General Recommendations

1. Provide nutrition education-early
2. Nutrition assessment-continual
   • Diet history
   • Nutrient intake calculation
   • Anthropometric measurements
   • Lab tests-blood count for anemia
     • serum albumin for PCM
     • retinol binding protein
     • prealbumin
   • Functional tests of muscle strength-handgrip power
3. Small, frequent feedings
4. Patients consuming inadequate diet should take a 100% RDA vitamin pill.
5. Antifolate drug treatment for infection may increase patient’s folic acid requirements.
6. Measure intestinal absorption using D-xylose.
7. Stools should be cultured
8. With ulcers, avoid acidic, hard foods. Use cold foods, straws, medications.
9. Decrease caffeine-intestinal stimulant
10. If steatorrhea may require A D E K
11. Washing fruits/vegetables with warm soapy water and rinsing to avoid enteric infections. Avoid raw or undercooked eggs, soft ripe cheeses.
12. Use bleach to wipe kitchen surfaces.
13. Enteral support should be given, when needed
    • Oral
    • Transnasal
    • Percutaneous Endoscopic Gastrostomy
14. Parenteral support when GI tract totally non-functional.

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%.