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

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Some antiretroviral drugs may affect glucose metabolism and cause insulinresistance. Insulin resistance is associated with increased risk of diabetes(Gelato 2003). For diabetes, specific carbohydrate controlled diet, reduced intake ofrefined sugar and saturated fat, exercise, and antidiabetic medications arerecommended.Progressive lactic acidosis is a complication of NRTI therapy (Carr 2003). The signs ofsevere lactic acidemia include fatigue, weight loss, abdominal pain, dyspnea, liverdysfunction, and cardiac dysrhythmias. In case of any of these symptoms, stoppingthe NRTI may help.Table 2 lists the purposes, recommended consumption, and potential side effectssome of the better-known and more widely taken medications in resource-limitedsettings. This list is not comprehensive, and health workers and programs areencouraged to add or update the list as medications become available or their use isdiscontinued.Table 2 Modern medications and recommended food intakes and side effectsMedicationPurposeRecommended Tobe takenAbacavir (ABC) Antiretroviral Can be takenwithout regard tofood.ChloroquineTreatment ofmalariaWith foodDidanosine (ddl) Antiretroviral With water only,1hour before or 2hours after eating.Avoid alcohol. Donot take withjuice. Do not takewith antacidcontainingaluminum ormagnesiumPotential side effectsNausea, vomiting, fever,allergic reaction, anorexia,abdominal pain, diarrhea,anemia, rash, hypotension,pancreatitis, dyspnea,weakness and insomnia,cough, and headacheStomach pain, loss ofappetite, nausea, vomitingNot recommended for womenbreastfeedingAnorexia, diarrhea, nausea,vomiting, pain, headache,weakness, insomnia, rash, drymouth, lost of taste,constipation, stomatitis,anemia, fever, dizziness, andpancreatitis.253
MedicationPurposeRecommended Tobe takenEfavirenz Antiretroviral Can be takenwithout regard tofood. Avoidalcohol.Fluconazole Treatment of With foodcandida(thrush)Indinavir (IDV) Antiretroviral 1 hour before or 2hours after meal.Drink at least1,500ml of fluiddaily. Do not drinkgrapefruit juice asit may lower thelevel of medicinein the blood.Avoid St. John’sIsoniazidLamivudine(3TC)Treatment oftuberculosisAntiretroviralwort.1hour before or 2hours after meals.May cause possiblereactions withfoods such asbananas, beer,avocados, liver,smoked pickledfish, yeast andyogurt. Mayinterfere withvitamin B 6metabolism andrequire vitamin B 6supplementation.Avoid alcohol.Can be takenwithout regard tofood. Avoidalcohol.Lopinavir Antiretroviral Can be takenwithout regard toPotential side effectsElevated blood cholesterollevels, elevated triglycerideslevels, rash, dizziness,anorexia, nausea, vomiting,diarrhea, dyspepsia,abdominal pain, flatulenceNausea, vomiting, diarrhea.Can be used duringbreastfeeding.Nausea, abdominal pain,headache, kidney stones,taste changes, vomiting,regurgitation, diarrhea,insomnia, ascites, weakness,and dizziness. May increasethe risk of lipodystrophy.Anorexia and diarrhea.Nausea, vomiting, headache,dizziness, diarrhea,abdominal pain, nasalsymptoms, cough, fatigue,pancreatitis, anemia,insomnia, muscle pain, andrash.Abdominal pain, diarrhea,headaches, headache,254
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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.
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HANDOUT 6.1 Health Sector and Mater
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HANDOUT 6.2 A Guide to Nutritional
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• Educational levelLactating moth
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Did the counselor ask about: YES NO
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HANDOUT 6.4 Practical Consideration
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HANDOUT 6.5 Checklist for Nutrition
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HANDOUT 6.7 Dietary Management of C
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Dietary problemFeverNutritional int
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1. How could HIV infection affect R
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• Nutritional status, dietary int
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• Rita’s dietary intake and eat
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• Eating smaller, more frequent e
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• How was the nutritional assessm
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Estimated time: 120 minutes excludi
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Suggested reading materialsCoutsoud
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LECTURE NOTES 7: INFANT FEEDING AND
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• A viral, bacterial, or parasiti
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DNA (cell-associated virus) in colo
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Mucosal integrity (slide 18)Studies
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PMTCT interventions are most effect
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Breastfeeding techniquesIt is espec
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women with HIV/AIDS for additional
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• Providing skin-to-skin contact
Page 214 and 215: suitable for replacement feeds befo
Page 216 and 217: • Administration of ZVD and Lamiv
Page 218 and 219: Coutsoudis, A, et al. 2001. Are HIV
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
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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 266 and 267: MedicationPurposeRecommended Tobe t
Page 268 and 269: intake and poor nutrient absorption
Page 270 and 271: Anti-acid medications containing ma
Page 272 and 273: women’s nutritional status. It is
Page 274 and 275: Health provider capacityHealth prov
Page 276 and 277: • What foods should not be taken
Page 278 and 279: Gelato, M. 2003. Insulin and carboh
Page 280 and 281: eferred him to the counselor for th
Page 282 and 283: Medication Purpose Recommended Tobe
Page 284 and 285: Medication Purpose Recommended Tobe
Page 286 and 287: Side effects of each drug?Side effe
Page 288 and 289: PurposeTo provide basic information
Page 290 and 291: Factors in Transmissionand Vulnerab
Page 292 and 293: Impact on the Education Sector• D
Page 294 and 295: AcknowledgmentNutrition and HIV/AID
Page 296 and 297: Body Habitus ChangesMetabolic chang
Page 298 and 299: PurposeTo provide general nutrition
Page 300 and 301: Stages of HIV Disease andNutritionI
Page 302 and 303: IncreaseVitamin and Mineral IntakeS
Page 304 and 305: Lipodystrophy• Means fat maldistr
Page 306 and 307: PurposeTo introduce the constraints
Page 308 and 309: Effect of AIDS on Crop ProductionCr
Page 310 and 311: Pregnant and Lactating WomenFood an
Page 312 and 313: 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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