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

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Promote adequate nutrient intake (slides 17, 18)Most people living with HIV/AIDS report weight loss, but loss of weight amongHIV/AIDS patients is not only related to food intake. A number of other factorsshould be investigated to determine appropriate interventions. Hellerstein andKotler (1998) have suggested an algorithm for choosing the best option ofinterventions for patients with HIV/AIDS related weight loss (adapted figure below).Figure 1 Algorithm for managing weight loss in patients with HIV/AIDSEnergyintakeOK Diarrhea or no Metabolic normalmalabsorption parametersEtiologynot knownLOW YES AbnormalDX profile = OKStarvedmetabolism,decreased bodyfat/leanRX = Feed (IV,enteral, appetitestimulation),design meal plans,address negativelifestyles, andtreat symptomsthat may affectfood intakeDX profile =Starvedmetabolism,decreased bodyfat/leanRX = Treat GIdisorders and anyother infectionsand considersupplements, drugand foodinteractions, andhygiene/foodhandlingDX profile = Abnormalmetabolism, relativelyhigh fat/lean ratio;low testosterone.RX = Design anexercise plan, provideanabolic steroids orARVs?RX =Continueto feedandobserveTo prevent weight loss it is important to ensure adequate nutrient intake at alltimes. The following practices can help achieve this:• Provide information about a proper diet that is based on a variety of foods thatare locally available and acceptable and will help the patient diversify the dietand increase energy and nutrient intake.• Suggest a diet that provides adequate protein, carbohydrates, and otheressential nutrients to meet the increased nutritional requirements during HIVinfection.49
Low energy intake is just one of the possible causes of weight loss among peopleliving with HIV/AIDS. Other important factors that should be examined aremalabsorption (or related diarrhea) and metabolic reasons. However, malabsorptionand diarrhea should only be examined if levels of energy and nutrient intake areadequate and the client continues to lose weight. Though there are individualdifferences, the following recommendations apply to people living with HIV/AIDS:Energy requirements: HIV-infected asymptomatic people should increase energyintake by 10 percent over the level of energy intake recommended for healthy, non-HIV-infected people of the same age, sex, and physical activity level. HIV-infectedsymptomatic people should increase energy intake by 20 percent-30 percent overthe level of energy intake recommended for healthy, non-HIV-infected people of thesame age, sex, and physical activity level. The recommendation during thesymptomatic phase is a range from 20 percent to 30 percent because energy needsincrease as the disease progresses and opportunistic infections worsen (Seumo-Fossoand Cogill 2003).Protein requirements: HIV-infected asymptomatic and symptomatic people do notrequire additional protein beyond the intake level recommended for healthy noninfectedpeople of the same age, sex, and physical activity level. Although the onsetof opportunistic infections leads to nitrogen losses, studies have not demonstratedthat increased protein intake by HIV-infected people improves clinical outcomes. Itis important, however, to consider pre-existing or concurrent protein deficiencies.If carbohydrate intake is insufficient, protein is used to provide the body withenergy. When this happens, protein is not available to maintain muscle andstrengthen the immune system. This can lead to muscle wasting and increasedsusceptibility to infection of an already weakened immune system. The diet shouldtherefore contain foods that are sufficient in both energy (in the form ofcarbohydrates) and protein.Individualized meal plans (slide 19)Because each patient has unique social and medical characteristics, individualizedmeal plans need to be developed. Meal planning takes time and requires theinclusion of the following considerations:50
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
Page 9 and 10: ContentThe content is arranged in t
Page 11 and 12: The sessions can also be taught in
Page 13: OutlineContent Methodology TimingDe
Page 16 and 17: LECTURE NOTES 1: THE BASICS OF HIV/
Page 18 and 19: gradually weakened. The infected pe
Page 20 and 21: increase in HIV prevalence of 60 pe
Page 22 and 23: infection may have a rapid onset, l
Page 24 and 25: • Dot-blot immunobinding assayUri
Page 26 and 27: • Removal of children from school
Page 28 and 29: effectively, care and support inter
Page 31 and 32: DISCUSSION POINTS 1================
Page 34 and 35: Recommended preparation1. Be famili
Page 36 and 37: LECTURE NOTES 2: LINK BETWEEN NUTRI
Page 38 and 39: AIDS, the impairment of immune func
Page 40 and 41: for healthy, non-HIV-infected peopl
Page 42 and 43: Low blood levels of several nutrien
Page 44 and 45: • Finally, a study of AIDS patien
Page 46 and 47: EXERCISE 2=========================
Page 48 and 49: SESSION 3 NUTRITION ACTIONS FOR PEO
Page 50 and 51: Required materials• LCD or overhe
Page 52 and 53: McDermott, AY, A Shevitz, T Knox, R
Page 54 and 55: Goals of nutritional care and suppo
Page 56 and 57: • Circumferences of the waist, hi
Page 58 and 59: Consider the phase of the HIV infec
Page 62 and 63: Stages of illness and symptoms. Sym
Page 64 and 65: TherapyNitrogenretention[g/day]Rate
Page 66 and 67: Nutrient supplements for people liv
Page 68 and 69: Conclusion (slide 31)Nutritional ca
Page 70 and 71: HANDOUT 3.1 Case studies in HIV and
Page 72 and 73: HANDOUT 3.2 Safe Food Handling Prac
Page 74 and 75: OutlineContent Methodology Timing1.
Page 76 and 77: Recommended preparation• Be famil
Page 78 and 79: PVO-USAID Steering Committee on Mul
Page 80 and 81: Nutritional care and support of peo
Page 82 and 83: In this session “food security co
Page 84 and 85: HIV/AIDS attacks food security not
Page 86 and 87: • Human capital: Reduced producti
Page 88 and 89: Food-insecure populations may also
Page 90 and 91: Food security constraints to nutrit
Page 92 and 93: Pregnant and lactating women (slide
Page 94 and 95: Implementation of nutritional care
Page 96 and 97: demand these foods. A good assessme
Page 98 and 99: Counselors should be aware of and i
Page 100 and 101: Conclusion (slide 36)The capacity t
Page 102 and 103: UNAIDS and WHO. 2002. AIDS epidemic
Page 104 and 105: 1. How does poor food availability
Page 106 and 107: 5. Will referrals and targeting of
Page 108 and 109: SESSION 5 NUTRITIONAL MANAGEMENT OF
Page 110 and 111:
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
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Enhanced ARV therapy (slide 29)Chil
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• Refer children with severe maln
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DISCUSSION POINTS 8Questions for cl
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Action/activityNorman admitted to n
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OutlineContent Methodology Timing1.
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• Allocate time for each activity
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Food Medication Interactionswww.foo
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• Describes information collected
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• Antimalaria drugs such as quini
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Food effects on drug efficacy (slid
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Some antiretroviral drugs may affec
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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
Page 344 and 345:
SIDE EFFECTS OF DRUGSaffectFOOD INT
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Nutrition and HIV/AIDS: A Training Manual - Linkages Project

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