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

Lipodystrophy• Means fat maldistribution• Is observed in 6%-80% of patients on ARVs• Is caused by metabolic changes associated with immunereconstitution and ARV mitochondrial toxicity• Results in− Hyperlipidemia− Hyperglycemia, insulin resistance, and glucose intolerance− Peripheral wasting (extremities, face)− Visceral and subcutaneous central adiposity (buffalo hump,breast enlargement)• Managed by exercise trainingHyperglycemiaand Insulin Resistance• Hyperglycemia: Increased blood sugar levelsfrom pancreatic problems or insulin resistance• Insulin resistance (impaired message system)reported in 28%-35% of adult patients on ARVs• Few cases of diabetes (3%-9%)• Management with− Antidiabetic agents− Antioxidants (e.g., vitamin C and selenium) tosupport glutathione, which is crucial in insulinactionHyperlipidemia• Changes triglycerides or cholesterol with or withoutfat maldistribution• Is caused by ARV interference with normal cellularproteins involved with lipid metabolism• Increases levels of triglycerides or cholesterol andrisk of cardiovascular problems and pancreatitis• Is managed by− Lipid-lowering drugs− Decreased fat intake− Exercise− Lifestyle changes (e.g., quitting smoking)Nutritional Care and SupportStrategies with ARV Therapy• Promote a nutritionally adequate diet (quality, diversity,and quantity)• Promote safe water, food, and hygiene practices• Discourage excessive fat intake (promote modest fats,starches, and sugars and high-protein food but fewerfried eggs and yolks), fatty meats, and animal fats• Prevent muscle wasting with regular exercise to burn fatand build muscle mass (anabolic agents?)• Encourage increased fluid intake• Address nutritional consequences of drug-nutrientinteractions and side effects of medicationsConclusions• Good nutrition and healthy lifestyle can preservehealth, improve quality of life, prolongindependence, and delay disease progression• Appropriate physical activity, increases energy,stimulates appetite, and preserves and builds leanbody mass• Preventing food- and water-borne infections reducesthe risk of diarrhea (a common cause of weightloss), malnutrition, and HIV disease progression• Antiretroviral therapy can help improve quality oflife, but patients should be educated on adversenutrition-related effects