National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

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CHAPTER 9 PLWHA may take various types of medications to reduce the effects of HIV on the body, to treat opportunistic infections, and other common ailments such as colds, malaria, and/or intestinal parasites. Some also use herbal remedies and take micronutrient supplements. Though there is no cure yet for HIV/AIDS, antiretroviral (ARV's) drugs are being used to manage HIV by lowering the viral load and thus reducing morbidity and mortality. Effective medical treatment can slow the progression of HIV, reduce opportunistic infections, and ease symptoms, but food can interact with drugs and affect the drugs' efficacy. Drugs can also interact with foods and nutrients and negatively affect nutritional status. The side effects of both traditional and modern medications can affect both food intake and nutrient absorption and thereby the client's adherence to medications. Additionally, drugs and food can interact to cause adverse effects. Ultimately, if not addressed, drug and food interactions can result in deterioration of health and nutritional status. The purpose of this chapter is to provide information on Anti-retroviral drugs (ARVs), their interactions with food, and potential side effects, traditional remedies and other therapies as well as counseling on nutrition and HIV/AIDS therapy. 9.1 Anti-Retroviral Drugs (ARVs) NUTRITION AND HIV/AIDS THERAPY ARVs significantly reduce the replication of HIV in the body and slow the progression of the disease. They are classified into three different groups namely; Reverse transcriptase inhibitors, Protease inhibitors (PIs) and Fusion inhibitors (refer to table 9.1). Table 9.1: Classes, Types and Examples of ARVs Class Reverse Transcriptase inhibitor Protease inhibitor Fusion inhibitor Type Non-nucleoside reverse transcriptase inhibitor (NNRTI) Nucleoside reverse transcriptase inhibitor (NRTI) Nucleotide reverse transcriptase inhibitor (NtRTI) Protease inhibitor (PI) Fusion inhibitor (FI) Examples of Drugs *Efavirenz (EFV) Delavirdine (DLV), *Nevirapine (NVP) *Abacavir (ABC) *Didanosine (ddl), Emtricitabine (FTC) *Lamivudine (3TC), *Stavudine (d4T) Zalcitabine (DDC), *Zidovudine (ZDV) *Tenofovir (TDF) Atazanavir (ATV), Amprenavir (APV) Fosamprenavir (f-APV) *Indinavir (IDV) *Lopinavir/Ritonavir (LPV/r) *Nelfinavir (NFV), *Saquinavir (SQV) Enfuvirtide (T-20) * Drugs marked in asterix are those currently available in Botswana. 38
9.1.1 Mode of Action of ARV drugs Each type of ARV is active at different stages of the virus' replication. Three or more ARVs are generally combined to enhance their efficacy in suppressing this replication. This is referred to as Highly Active Antiretroviral Therapy (HAART). For example, the action of the antiretroviral Zidovudine is enhanced if used in combination with Lamivudine and Efavirenz or Nevirapine. Thus a person who is on treatment for HIV/AIDS will have to take a combination of ARVs rather than one or two. Fusion inhibitors are a new type of ARV that prevents HIV from binding to the surface of the T-cell and infecting the T-cell. HIV-positive people who have become resistant to PIs, NRTIs, and NNRTIs are likely to benefit from the fusion inhibitors because they are a different type of ARV. 9.2 ARV and Non-ARV Drugs Interactions with Food and Their Potential Side Effects Modern and traditional medications can interact with food in four major ways as illustrated in Figure 9.1. Proper dietary management interventions can help manage some of these negative effects and can also help PLWHA maintain adequate food intake and compensate for affected nutrients. Figure 9.1: Types of Interactions between Medications and Food 1 FOOD MEDICATION ABSORPTION, METABOLISM Affects DISTRIBUTION, EXCRETION 2 MEDICATION NUTRIENT ABSORPTION, METABOLISM, Affects DISTRIBUTION, EXCRETION 3 MEDICATIONS' FOOD INTAKE & NUTRIENT ABSORPTION SIDE EFFECT Affects 4 MEDICATION + UNHEALTHY SIDE EFFECTS CERTAIN FOODS Creates Source: Castleman et al forthcoming 9.2.1 Effects of Food on Drug Efficacy Food intake or meals can enhance or inhibit the absorption, metabolism, distribution, and excretion of medications. This type of interaction varies from one drug to another and requires appropriate dietary responses to improve the client's adherence and optimize the medication's efficacy. Dietary management to improve the efficacy of a medication includes taking the medication with food, on an empty stomach, or with or without certain types of foods (Table 9.2). Examples of the ways food intake affects drug efficacy are: ° Food enhances the absorption or metabolism of some ARVs and inhibits the absorption or metabolism of others. For example, a high-fat meal increases the bioavailability of the nucleotide analogue Tenofovir (Pronsky, Meyer, and Fields-Gardner 2001). A high-calorie, high-fat, high-protein meal decreases absorption of the protease inhibitor Indinavir and reduces the absorption of the nucleoside reverse transcriptase inhibitor Zidovudine. It is therefore recommended not to take Zidovudine with high-fat meals e.g. fried foods, foods high in animal fat (saturated fats). ° Food reduces the absorption of Isoniazid and Rifampin, medications commonly used to treat tuberculosis. Therefore, Isoniazid and Rifampin have to be taken 1 hour before or 2 hours after meals. ° Food reduces the rate of absorption of aspirin (acetylsalicylic acid), used to treat fever and pain that are common in people living with HIV/AIDS. Aspirin is best taken 2 hours after meals with a full glass of water (notwithstanding its gastric erosive properties). 39
Page 1: NATIONAL NUTRITION AND HIV/AIDS GUI
Page 5: ACKNOWLEDGEMENTS Developing these g
Page 8 and 9: 4.1.3 Symptomatic 18 4.1.4 Advanced
Page 10 and 11: TECHNICAL WORKING TEAM MEMBERS 1 Mr
Page 12 and 13: GLOSSARY LIST Asymptomatic: When a
Page 14 and 15: declining though still high, from 4
Page 16 and 17: 1.8 Layout of the Guidelines Each c
Page 18 and 19: Table 2.1: Summary table for the fo
Page 20 and 21: provide fiber. Nutrients found in v
Page 22 and 23: 2.3.5 Milk and Dairy Foods Milk and
Page 24 and 25: social and health effects. Some of
Page 26 and 27: CHAPTER 3 THE RELATIONSHIP BETWEEN
Page 28 and 29: Table 3.1 WHO Clinical classificati
Page 30 and 31: clients, preference should be given
Page 32 and 33: nutrition. PLWHA found to fit in th
Page 34 and 35: 4.3.3 Clinical The key in clinical
Page 36 and 37: 5.1.1 Nutritional Screening It is r
Page 38 and 39: ° Ensure that all immunizations an
Page 40 and 41: neglect children, have mental healt
Page 42 and 43: Table 6.1 Specific feeding recommen
Page 44 and 45: 7.1.2 Protein Requirements The prot
Page 46 and 47: CHAPTER 8 PROTECT THE QUALITY AND S
Page 48 and 49: 8.5 Hygiene in the Kitchen ° Keep
Page 52 and 53: As the effect of food on the effica
Page 54 and 55: Medication Purpose Recommendation/
Page 56 and 57: Appropriate dietary responses Appro
Page 58 and 59: that are presently marketed in Bots
Page 60 and 61: ° For PLWHA living in areas where
Page 62 and 63: HERB Sore mouth and throat Recommen
Page 64 and 65: CHAPTER 11 NUTRITION EDUCATION AND
Page 66 and 67: warmth, understanding, and respect
Page 68 and 69: CHAPTER 12 HIV/AIDS, NUTRITION AND
Page 70 and 71: younger siblings. ° Sale of key as
Page 72 and 73: ° Emphasize and support small scal
Page 74 and 75: ° Are there any dietary changes am
Page 76 and 77: ANNEXES ANNEX 1: Scientific Or Engl
Page 78 and 79: ANNEX 3: Nutrient Composition of a
Page 81 and 82: Annex 5: National Nutrition and HIV
Page 83: 12.6. Strongly Disagree 13. During

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