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

Stages of HIV Disease andNutritionInterventionsSpecific nutrition recommendations varyaccording to underlying nutritionalstatus and HIV disease progression• Early stage: No symptoms, stable weight• Middle stage: Weight loss, opportunisticinfections associated effects• Late stage: Symptomatic AIDSNutrition Care and SupportPriorities by Stage of DiseaseAsymptomatic: Counsel to stay healthy• Encourage building stores of essential nutrients andmaintaining weight and lean body mass• Ensure understanding of food and water safety• Encourage physical activityMiddle stage – Counsel to minimize consequences• Counsel to maintain dietary intake during acute illness• Advise increased nutrient intake to recover and gain weight• Encourage continued physical activityLate stage: Provide comfort• Advise on treating opportunistic infections• Counsel to modify diet according to symptoms• Encourage eating and physical activityNutrition Actions for HIV-Infected PeopleTo prevent weight loss• Promote adequate energy and protein intake• Individualize meal plan and modify to matchmedication regime or health changes• Advise changing lifestyles that negatively affectenergy and nutrient intakeTo improve body composition• Promote regular exercise to preserve muscle mass• Promote steroidsTo improve immunity and prevent infections• Promote increased vitamin and mineral intake• Promote food safety• Promote use of ARVs to reduce viral loadAlgorithm for Managing WeightLoss in Patients with HIV/AIDSPromote AdequateNutrient IntakeEnergy OK Diarrhea or malabsorption?NO Metabolicintake?parameters NormalLOW YES AbnormalDX Profile=starvedDX Profile=starved DX Profile=abnormalmetabolism, decreased metabolism, decreased metabolism, relativelybody fat/leanbody fat/leanhigh fat/lean ratio; lowRX=Feed (IV, enteral,RX= Treat GI disorderstestosterone.appetite stimulation),and other infections, RX=Make an exercisemake meal plans,consider supplements plan, provide metabolicpromote positiveand drug-foodsteroids (?) and ARVs (?)lifestyles, treatinteractions, counsel onsymptoms that mayhygiene and foodaffect food intakehandlingSource: Adapted from Hellerstein and Kotler 1998Etiology unknownor unclearRX=Continue tofeed and observe• Identify locally available and acceptable foods• Promote a diet adequate in energy, protein andother essential nutrients− Increase energy intake by 10%-15%− Increase protein intake− Increase eating a variety of foods (especiallymore fruits and vegetables) and/or promotemultiple micronutrient supplements forimproved immune function