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

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As the effect of food on the efficacy of a drug is food and drug specific, the counsellor should help the client draw up a food and drug timetable. This timetable should take into account both the food and drug interactions of each drug to be taken and the client's eating habits to ensure the greatest efficacy of the treatment. 9.2.2 Drug Effects on Nutrient Absorption, Metabolism, Distribution, and Excretion Certain medications affect nutrient absorption, metabolism, and excretion hence could have negative effects on nutritional status. Dietary management may require either increasing food intake, taking a nutrient supplement to compensate for the nutrient affected, or reducing the nutrient intake if the metabolite produced can negatively affect health. Drugs that may require increased food or nutrient intake: The medication Isoniazid, commonly taken to treat tuberculosis, inhibits the metabolism of vitamin B6. The antibiotic and anti-tuberculosis medication Rifampin may increase vitamin D metabolism. Supplementation of these vitamins is therefore recommended as necessary. Drugs that may require reduced food or nutrient intake: Studies have reported lipid abnormalities, such as increased level of triglycerides, cholesterol, and fat mal-distribution in people who have taken protease inhibitors or non-nucleoside reverse transcriptase inhibitors. The protease inhibitors Saquinavir and Ritonavir may cause an elevation in cholesterol and triglycerides levels, which may increase the risk of cardiovascular diseases (Pronsky, Meyer, and Fields-Gardner 2001). Most of the protease inhibitors may cause changes in lipid levels that require both dietary and medical responses. Lipid abnormalities include hypertriglyceridemia, hypercholesterolemia, and lipodystrophy syndrome: ° For hypertriglyceridemia, it is important to maintain a healthy weight, eat a variety of foods, reduce the intake of refined sugar and excessive carbohydrates, increase intake of fibre, avoid alcoholic beverages, exercise daily, and take medication to lower triglycerides. ° For hypercholesterolemia, it is important to maintain a healthy weight, eat a diet low in fat and limited saturated fat, increase intake of fruits and vegetables, avoid food rich in cholesterol, avoid alcohol and smoking, exercise daily, and take medication to lower the cholesterol (Pronsky, Meyer, and Fields-Gardner, 2001) ° The effective management of fat mal-distribution or lipodystrophy syndrome has not yet been established. Diet and exercise, use of medications, and change in the ARV regimen can help. Some antiretroviral drugs may affect glucose metabolism and cause insulin resistance. Insulin resistance is associated with increased risk of diabetes (Gelato 2003). For diabetes, specific carbohydrate controlled diet, reduced intake of refined sugar and saturated fat, exercise, and antidiabetic medications are recommended. Progressive lactic acidosis is a complication of NRTI therapy (Carr 2003). The signs of severe lactic acidemia include fatigue, weight loss, abdominal pain, dyspnea, liver dysfunction, and cardiac dysrhythmias. In case of any of these symptoms, the client should be referred for further management. 9.2.3 Drug Side Effects The side effects of drugs on food intake and the effects of drugs on nutrient absorption, metabolism, distribution and excretion may have the most negative impact on the nutritional status of PLWHA. The side effects of drugs and the effects of the disease are often difficult to distinguish. For example, headaches, malaise, fever, and gastrointestinal symptoms may be side effects of drugs but can also be associated with HIV and AIDS. 9.2.4 Effects of drug side effects on food intake and nutrient absorption 40
Modern and traditional medications may cause side effects that affect food intake and nutrient absorption. Side effects may include changes in taste, loss of appetite, nausea, bloating and heartburn, constipation, vomiting and diarrhea that affect food intake and nutrient absorption. Changes in taste, loss of appetite, nausea, bloating and heartburn, and constipation may lead to reduced food intake, whereas vomiting and diarrhea can cause poor nutrient absorption. Reduced food intake and poor nutrient absorption can lead to the weight loss and wasting associated with faster progression of HIV to AIDS. Table 9.2 lists the purposes, recommendation/ advice, and potential side effects of some of the widely taken medications treating HIV/AIDS, opportunistic infections and other conditions. This list is not comprehensive, health workers and other service providers are encouraged to update the list as medications become available or their use is discontinued. 9.2.5: Storage of drugs. Some medications are sensitive to storage temperature. D4T liquid is very unstable at room temperature so it must be kept refrigerated at all times. Some medications, for example Kaletra's capsule do not need to be refrigerated, but must be kept in a cool place in the house. In general however, day time temperatures in Botswana can be too hot even for those medications which do not normally require refrigeration. Therefore PLWHA on ARV must be properly educated on the safer places to store their medications. In general most medications will keep well in a cupboard in the house. Preference should be in a cupboard or table that is shaded from direct sunlight at any time of the day. Storing medications on window sill must be discouraged because the temperature there can be very high. Table 9.2: Recommendations/Advice for Taking ARVs and Other Medications Medication Purpose Recommendation/ advice Potential side effects Abacavir (ABC) Antiretroviral Can be taken without regard to food Nausea, vomiting, fever, allergic reaction, anorexia, abdominal pain, diarrhoea, anaemia, rash, hypotension, pancreatitis, dyspnoea, weakness and insomnia, cough, and headache Didanosine (ddI) Antiretroviral With water only, 1hour before or 2hours after eating. Avoid alcohol. Do not take with juice. Do not take with antacid containing aluminium or magnesium. Anorexia, diarrhoea, nausea, vomiting, pain, headache, weakness, insomnia, rash, dry mouth, loss of taste, constipation, stomatitis, anaemia, fever, dizziness, and pancreatitis. Efavirenz (EFV) Antiretroviral Can be taken without regard to food. Take at bedtime. Avoid alcohol. Elevated blood cholesterol levels, elevated triglycerides levels, nightmares, rash, dizziness, anorexia, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence Indinavir (IDV) Antiretroviral 1 hour before or 2 hours after meal. Drink at least 1,500ml of fluid daily. Do not drink grapefruit juice as it may lower the level of medicine in the blood. Avoid St. John's wort. Nausea, abdominal pain, headache, kidney stones, taste changes, vomiting, regurgitation, diarrhea, insomnia, ascites, weakness, and dizziness. May increase the risk of lipodystrophy. Lamivudine (3TC) Antiretroviral Can be taken without regard to food. Avoid alcohol. Nausea, vomiting, headache, dizziness, diarrhea, abdominal pain, nasal symptoms, cough, fatigue, pancreatitis, anaemia, insomnia, muscle pain, and rash 41
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 50 and 51: CHAPTER 9 PLWHA may take various ty
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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