Nutrition and HIV/AIDS: A Training Manual - Linkages Project

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Coutsoudis, A, et al. 2001. Are HIV-infected women who breastfeed at increased riskof mortality? AIDS 15: 653-55.Coutsoudis, A, K Pillay, E Spooner, et al. 1999. Randomized trial testing the effect ofvitamin A supplementation on pregnancy outcomes and early mother-to-child HIVtransmission in Durban, South Africa. AIDS 13: 1517-24.Dabis, F, V Leroy, K Castetbon, et al. 2000. Preventing MTCT of HIV-1 in Africa in theyear 2000. AIDS 14: 1017-26.Dabis, F, ML Newell, L Fransen, et al. 2000. Prevention of MTCT of HIV in developingcountries: Recommendations for practice. Health Policy Plan 15(1): 34-42.Dunn, DT, ML Newell, AE Ades, and CS Peckham. 1992. Risk of humanimmunodeficiency virus type 1 transmission through breastfeeding. Lancet 340: 585-88.Featherstone, C. 1997. M cells: Portals to the mucosal immune system. Lancet 350:1230.Goldman, A. 1993. The immune system of human milk: Antimicrobial, antiinflammatoryand immunomodulating properties. Pediat Infect Dis J 12: 664-71.Guay, L, P Musoke, T Fleming, et al. 1999. Intrapartum and neonatal single doseNevirapine compared with Zidovudine for prevention of MTCT of HIV-1 in Kampala,Uganda: HIVNET 012 randomised trial. Lancet 354: 795-802.Harmsen, MC, PJ Swart, and MP de Bethune. 1995. Antiviral effects of plasma andmilk proteins: Lactoferrin shows potent activity against both humanimmunodeficiency virus and human cytomegalovirus replication in vitro. J Infect Dis172: 380-388.Isaacs, CE, and H Thormar. 1990. Human milk lipids inactivate enveloped viruses. InSA Atkinson, LA Hanson, and RK Chandra, Breastfeeding, nutrition infections andinfant growth in developed and emerging countries. St. John, Canada: ARTSBiomedical Publishers and Distributors.207
Joint United Nations Programme on HIV/AIDS. 2000. Report on the Global HIV/AIDSEpidemic. Geneva: UNAIDS.Lewis, P, R Nduati, JK Kreiss, et al. 1998. Cell-free human immunodeficiency virustype 1 in breast milk. J Infect Dis 177: 7-11.Livingston, R, N Hutton, N Halsey, et al. 1995. HIV specific IgA in infants born to HIVseropositive women. Pediatric Adolescent Med 149: 503-07.Newburg, DS, RP Viscidi, A Ruff, and RH Yolken. 1992. A human milk factor inhibitsbinding of human immunodeficiency virus to the CD4 receptor. Paediatric Research31: 22-28.Nduati, R, G John, B Richardson, et al. 1995. Human immunodeficiency virus type-1infected cells in breast milk: Association with immunosuppression and vitamin Adeficiency. J Infect Dis 172: 1461-68.Orloff, SL, JC Wallingfor, and JS McDougal. 1993. Inactivation of humanimmunodeficiency virus type 1 in human milk: Effects of intrinsic factors in humanmilk and of pasteurization. J Human Lactation 9: 13-17.Piwoz, E, J Ross, and J Humphrey. 2003. HIV transmission during breastfeeding:Knowledge, gaps, and challenges for the future. In Advances in experimentalmedicine and biology, protecting infants through human milk: Advancing thescientific evidence base. Kluwer Publishing (in press).Ross, J. 1999. A spreadsheet model to estimate the effects of different infantfeeding strategies on mother-to-child transmission of HIV and on overall infantmortality. Washington, DC: Academy for Educational Development/LINKAGESProject.Ryder, RW, T Manzila, E Baende, et al. 1991. Evidence from Zaire that breastfeedingby HIV seropositive mothers is not a major route for perinatal HIV-1 transmission butdoes decrease morbidity. AIDS 5: 709-14.208
Page 1 and 2:
Regional Centrefor Quality ofHealth
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ACKNOWLEDGMENTSThis training manual
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ABBREVIATIONS AND ACRONYMSACCAIDSAN
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INTRODUCTIONThe coexistence of high
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ContentThe content is arranged in t
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The sessions can also be taught in
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OutlineContent Methodology TimingDe
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LECTURE NOTES 1: THE BASICS OF HIV/
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gradually weakened. The infected pe
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increase in HIV prevalence of 60 pe
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infection may have a rapid onset, l
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• Dot-blot immunobinding assayUri
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• Removal of children from school
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effectively, care and support inter
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DISCUSSION POINTS 1================
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Recommended preparation1. Be famili
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LECTURE NOTES 2: LINK BETWEEN NUTRI
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AIDS, the impairment of immune func
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for healthy, non-HIV-infected peopl
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Low blood levels of several nutrien
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• Finally, a study of AIDS patien
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EXERCISE 2=========================
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SESSION 3 NUTRITION ACTIONS FOR PEO
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Required materials• LCD or overhe
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McDermott, AY, A Shevitz, T Knox, R
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Goals of nutritional care and suppo
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• Circumferences of the waist, hi
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Consider the phase of the HIV infec
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Promote adequate nutrient intake (s
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Stages of illness and symptoms. Sym
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TherapyNitrogenretention[g/day]Rate
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Nutrient supplements for people liv
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Conclusion (slide 31)Nutritional ca
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HANDOUT 3.1 Case studies in HIV and
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HANDOUT 3.2 Safe Food Handling Prac
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OutlineContent Methodology Timing1.
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Recommended preparation• Be famil
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PVO-USAID Steering Committee on Mul
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Nutritional care and support of peo
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In this session “food security co
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HIV/AIDS attacks food security not
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• Human capital: Reduced producti
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Food-insecure populations may also
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Food security constraints to nutrit
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Pregnant and lactating women (slide
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Implementation of nutritional care
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demand these foods. A good assessme
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Counselors should be aware of and i
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Conclusion (slide 36)The capacity t
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UNAIDS and WHO. 2002. AIDS epidemic
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1. How does poor food availability
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5. Will referrals and targeting of
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SESSION 5 NUTRITIONAL MANAGEMENT OF
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Required materials• LCD or overhe
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LECTURE NOTES 5: NUTRITIONAL MANAGE
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Figure 2 Cycle of malnutrition and
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IV. Late symptomatic phase (full-bl
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The following symptoms may also neg
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• Enables greater food intake by
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EXERCISE 5=========================
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HANDOUT 5.1 Caring for symptoms ass
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Illness Diet Care and nutrition pra
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SESSION 6 NUTRITIONAL CARE AND SUPP
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OutlineContent Methodology Timing1.
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Recommended preparation• Be famil
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———. 1998. Randomised trial o
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LECTURE NOTES 6: NUTRITIONAL CARE A
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The stigma associated with HIV can
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of malnutrition, which increases th
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adolescent mother, growth and devel
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HIV infection increases the energy
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Anemia is common during HIV infecti
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The use of high levels of supplemen
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Nutritional care and support for th
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Management of secondary infections
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A. Nutrition history• Dietary int
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• Income, housing, amenities for
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multiple nutrient supplement, where
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Management of diet-related HIV prob
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Infant feeding options and risks (s
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insecurity and may increase malnutr
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Seumo-Fosso, E, and B Cogill. 2003.
Page 168 and 169: HANDOUT 6.1 Health Sector and Mater
Page 170 and 171: HANDOUT 6.2 A Guide to Nutritional
Page 172 and 173: • Educational levelLactating moth
Page 174 and 175: Did the counselor ask about: YES NO
Page 176 and 177: HANDOUT 6.4 Practical Consideration
Page 178 and 179: HANDOUT 6.5 Checklist for Nutrition
Page 180 and 181: HANDOUT 6.7 Dietary Management of C
Page 182 and 183: Dietary problemFeverNutritional int
Page 184 and 185: 1. How could HIV infection affect R
Page 186 and 187: • Nutritional status, dietary int
Page 188 and 189: • Rita’s dietary intake and eat
Page 190 and 191: • Eating smaller, more frequent e
Page 192 and 193: • How was the nutritional assessm
Page 194 and 195: Estimated time: 120 minutes excludi
Page 196 and 197: Suggested reading materialsCoutsoud
Page 198 and 199: LECTURE NOTES 7: INFANT FEEDING AND
Page 200 and 201: • A viral, bacterial, or parasiti
Page 202 and 203: DNA (cell-associated virus) in colo
Page 204 and 205: Mucosal integrity (slide 18)Studies
Page 206 and 207: PMTCT interventions are most effect
Page 208 and 209: Breastfeeding techniquesIt is espec
Page 210 and 211: women with HIV/AIDS for additional
Page 212 and 213: • Providing skin-to-skin contact
Page 214 and 215: suitable for replacement feeds befo
Page 216 and 217: • Administration of ZVD and Lamiv
Page 220 and 221: Semba, RD, N Kumwenda, D Hoover, et
Page 222 and 223: Case study 1A school teacher, Regin
Page 224 and 225: • How would you respond to Hilary
Page 226 and 227: HANDOUT 7.2 PMTCT Decision-Making A
Page 228 and 229: OutlineContent Methodology Time1. E
Page 230 and 231: Suggested reading materialsAgostoni
Page 232 and 233: LECTURE NOTES 8: NUTRITION AND HIV/
Page 234 and 235: Despite these statistics, it is dif
Page 236 and 237: Etiology of growth failure among HI
Page 238 and 239: oys. Micronutrient deficiencies wil
Page 240 and 241: • Changes in eating behaviors ass
Page 242 and 243: • Address issues relevant and of
Page 244 and 245: Enhanced ARV therapy (slide 29)Chil
Page 246 and 247: • Refer children with severe maln
Page 248 and 249: DISCUSSION POINTS 8Questions for cl
Page 250 and 251: Action/activityNorman admitted to n
Page 252 and 253: OutlineContent Methodology Timing1.
Page 254 and 255: • Allocate time for each activity
Page 256 and 257: Food Medication Interactionswww.foo
Page 258 and 259: • Describes information collected
Page 260 and 261: • Antimalaria drugs such as quini
Page 262 and 263: Food effects on drug efficacy (slid
Page 264 and 265: Some antiretroviral drugs may affec
Page 266 and 267: MedicationPurposeRecommended Tobe t
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intake and poor nutrient absorption
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Anti-acid medications containing ma
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women’s nutritional status. It is
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Health provider capacityHealth prov
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• What foods should not be taken
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Gelato, M. 2003. Insulin and carboh
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eferred him to the counselor for th
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Medication Purpose Recommended Tobe
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Medication Purpose Recommended Tobe
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Side effects of each drug?Side effe
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PurposeTo provide basic information
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Factors in Transmissionand Vulnerab
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Impact on the Education Sector• D
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AcknowledgmentNutrition and HIV/AID
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Body Habitus ChangesMetabolic chang
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PurposeTo provide general nutrition
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Stages of HIV Disease andNutritionI
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IncreaseVitamin and Mineral IntakeS
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Lipodystrophy• Means fat maldistr
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PurposeTo introduce the constraints
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Effect of AIDS on Crop ProductionCr
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Pregnant and Lactating WomenFood an
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Session 5 Nutritional Management of
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Rationale, Cont.Importance of Manag
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Session 6 Nutritional Care and Supp
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Vulnerabilityof Women and Young Gir
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What Is Not KnownComparison of Nutr
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Purposeof Nutrition Care and Suppor
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Greatest Impact of NutritionImprove
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Size of the Problem in Africa• >3
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Possible Mechanisms ofTransmissionA
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Prevention-to-Care ContinuumInterve
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Session 8 Nutritional Care for Youn
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ChildrenBorn to HIV-Positive Mother
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Growth Failure Associated withIncre
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Enhanced ARV Therapy• To reduce v
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Care of the Terminally Ill ChildWhy
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PurposeTo provide knowledge and ski
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SIDE EFFECTS OF DRUGSaffectFOOD INT
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