Hazel's slide content

SLIDE 2

The role for nutrition in the management of HIV has received much attention over the past 10 years. Earlier work focused on nutritional problems caused by HIV.

Agenda

·         Nutritional problems caused by HIV

·         Nutritional problems associated with combination anti-retroviral therapy

Practical suggestions for improving food intake in symptomatic AIDS

SLIDE 3

HIV wasting has been one of the most challenging complications of the disease. The characteristics of malnutrition in AIDS are:

Malnutrition in AIDS

·         Degree of malnutrition is extreme

·         BCM becomes depleted out of proportion to weight loss

·         Relationship exists between BCM depletion and timing from death

·         Causes of malnutrition are multi-factorial

SLIDE 4

Slide of person with AIDS wasting

SLIDE 5

Impact of HIV wasting?

·         Loss of fat

·         Loss of fat free mass (lean body mass)

SLIDE 6

This slide helps to explain that HIV is associated with AIDS-related illnesses. Being HIV positive alone is not a risk factor for wasting

SLIDE 7

When does wasting occur?

·         Wasting not caused by HIV itself

·         Wasting is caused by secondary disease

SLIDE 8

Causes of weight loss

·         Decreased nutrient intake (food intake)

(Associated with 70-90% of weight loss)

·         Decreased absorption of food

(Associated with 10-30% of weight loss)

·         Increased metabolic rate

·         (Associated with 0-30% of weight loss)

SLIDE 9

It is important to consider the reason for nutritional intervention. The main reasons for interventions are:

Why provide nutrition intervention?

·         Increase fat free mass

·         Improve survival

·         Increase quality of life

SLIDE 10

Nutritional therapy – where do we begin?

·         Assess the clinical situation of patient

·         First line - diagnose underlying disease and start drug therapy

·         Assess nutritional status

–              Weight, height, body composition, plasma proteins

·         Perform diet history

–              Balance food groups and vitamins/minerals

–              Food safety

–              Plan the goals of diet therapy

SLIDE 11

Lipodsytrophy

·         Fat Re-distribution          

–              Central obesity

–              Peripheral wasting

–              Facial wasting

·         Metabolic problems

–              Hyperlipidaemia

–              Insulin resistance

SLIDES 12 and 13

Slides of Lipodystrophy

SLIDE 14

Dietary intervention

·         Aim for adequate energy and protein

·         Reduce a component of the diet if there is food intolerance

·         Personalise the diet plan if the symptoms are complex

SLIDE 15

Assessment of the patient with diarrhoea

·         Assess cause of diarrhoea

·         Assess ability to treat diarrhoea

·         Assess weight history

·         Assess diet

SLIDE 16

Summary

·         Opportunistic illness in is associated with gross nutritional depletion

·         Patients accessing anti-retroviral therapy experience fat redistribution and metabolic problems

·         Assess nutritional status and diet at onset of opportunistic illness

·         Individualise dietary advice