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

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AcknowledgmentNutrition and HIV/AIDS: A Training ManualSession 2Most of the slides in this presentation are thework of Ellen Piwoz (and Elizabeth Preble) ofthe SARA Project, Academy for EducationDevelopmentPurposeSession OutlineTo provide basic concepts of therelationship among food, nutrition, andHIV/AIDS; general dietary needs; andpractices to reduce morbidity, mortality,and the progression of HIV to AIDS• Link between HIV/AIDS and nutrition• Effects of HIV/AIDS on nutrition• Effects of nutrition (macronutrients,micronutrients and existing nutritionalstatus) on HIV/AIDSVicious Cycleof Malnutrition and HIVEffects of Malnutrition and HIV onthe Immune SystemIncreased Nutritionalneeds,Reduced food intakeand increased loss ofnutrientsPoor Nutritionresulting in weight loss,muscle wasting, weakness,nutrient deficienciesHIVIncreased vulnerability toinfections e.g. Entericinfections, flu, TB henceIncreased HIV replication,Hastened disease progressionIncreased morbidityImpaired immune systemPoor ability to fight HIVand other infections,Increased oxidativestressMalnutritionHIVCD4 T-lymphocyte numberCD8 T-lymphocyte numberDelayed cutaneous hypersensitivityCD4/CD8 ratioSerologic response after immunizationsBacteria killingSource: Adapted from RCQHC and FANTA 2003
Affects of HIV/AIDS on Nutrition• Decrease in the amount of foodconsumed• Impaired nutrient absorption• Changes in metabolismCauses of DecreasedFood Consumption• Mouth and throat sores• Loss of appetite leading to fatigue,depression, and changes in mental state• Side effects from medication• Abdominal pain• Household food insecurity and povertyPoor Nutrient Absorption• Nutrient absorption impaired during manyinfections• Poor absorption of fats and carbohydratesat all stages of HIV infection because of− HIV infection of intestinal cells− Frequent diarrhea and vomiting− Opportunistic infections• Poor absorption of fats that affects use offat-soluble vitamins such as A and EChanges in Metabolism• Infection increases energy (10%-15%) andprotein (50% or more) requirements• Infection increases demand for andutilization of antioxidant vitamins (E, C,beta-carotene) and minerals (zinc,selenium, iron)• Insufficient antioxidants from increasedutilization causes oxidative stress− Increases HIV replication− Leads to higher viral loadsHIV-Associated Wasting SyndromeBody weight is the most common bodycomposition measurement but isinaccurate because of:• Fluid overload (e.g., severe renal disease,IV rehydration)• Fluid deficits (e.g., dehydration fromdiarrhea, poor fluid intake)• Inability to differentiate between changesin lean tissues or fatHIV-AssociatedWasting Syndrome, Cont.Body cell mass is superior to body weight• Measures the metabolically active tissue compartment in thebody• Includes the muscles, organs, and circulating cells and so candifferentiate between lean tissues and fatStudies show• Progressive depletion of body cell mass in the late stages ofHIV disease (Kotler 1985)• Significant prolonged survival in patients with body cell mass>30% of body weight or serum albumin levels exceeding3.0g/dl (Suttman 1991)
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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
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suitable for replacement feeds befo
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• Administration of ZVD and Lamiv
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Coutsoudis, A, et al. 2001. Are HIV
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Semba, RD, N Kumwenda, D Hoover, et
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Case study 1A school teacher, Regin
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• How would you respond to Hilary
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HANDOUT 7.2 PMTCT Decision-Making A
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OutlineContent Methodology Time1. E
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Suggested reading materialsAgostoni
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LECTURE NOTES 8: NUTRITION AND HIV/
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Despite these statistics, it is dif
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Etiology of growth failure among HI
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oys. Micronutrient deficiencies wil
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• Changes in eating behaviors ass
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• 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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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 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
Page 314 and 315: Rationale, Cont.Importance of Manag
Page 316 and 317: Session 6 Nutritional Care and Supp
Page 318 and 319: Vulnerabilityof Women and Young Gir
Page 320 and 321: What Is Not KnownComparison of Nutr
Page 322 and 323: Purposeof Nutrition Care and Suppor
Page 324 and 325: Greatest Impact of NutritionImprove
Page 326 and 327: Size of the Problem in Africa• >3
Page 328 and 329: Possible Mechanisms ofTransmissionA
Page 330 and 331: Prevention-to-Care ContinuumInterve
Page 332 and 333: Session 8 Nutritional Care for Youn
Page 334 and 335: ChildrenBorn to HIV-Positive Mother
Page 336 and 337: Growth Failure Associated withIncre
Page 338 and 339: Enhanced ARV Therapy• To reduce v
Page 340 and 341: Care of the Terminally Ill ChildWhy
Page 342 and 343: PurposeTo provide knowledge and ski
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SIDE EFFECTS OF DRUGSaffectFOOD INT
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