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

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