Clinical Manual for Management of the HIV-Infected ... - myCME.com

Nutrition
Background
Maintaining good nutritional status is important to
support overall health and immune system function in
people with HIV/AIDS. Many HIV-related conditions
affect and are affected by the body’s nutritional status.
These include conditions related to HIV itself (eg,
opportunistic infections and other illnesses), comorbid
conditions, and adverse effects of therapies.
Inadequate nutrition in people with HIV infection may
result from many factors-including conditions such as
nausea, vomiting, or anorexia-that may prevent adequate
intake of nutrients and medications; diarrheal infections
that prevent absorption of nutrients and medications;
systemic illnesses (including HIV itself ) that create
a catabolic state; and psychological conditions (such
as depression) that impair patients’ ability to nourish
themselves. In addition, financial constraints may limit
patients’ access to nutritious food.
Evaluation and enhancement of patients’ nutritional
status may help correct or compensate for deficiencies
(eg, in the case of weight loss or nutrient deficits), may
be a key treatment modality for certain conditions (eg,
dyslipidemia, hyperglycemia), and may help to maintain
good health and immune function. This chapter
focuses on the evaluation of patients with nutritional
deficiencies, particularly weight loss, and simple
strategies for maintaining good nutrition in individuals
with barriers to maintaining adequate weight.
Ideally, HIV-infected individuals will receive the
services of HIV-experienced nutrition specialists, who
may contribute to the patient care team in the following
ways:
♦
♦
Conducting routine screening to identify and treat
nutritional problems
Preparing a tailored nutritional plan to optimize
patients’ nutritional status, immune status, and
overall well-being
Section 2—Health Maintenance and Disease Prevention | 2–5
♦
♦
♦
♦
♦
♦
♦
Screening and developing interventions for growth
problems in children
Developing strategies to prevent loss of weight and
lean body mass
Adapting dietary recommendations to help reduce
the risk of comorbid conditions such as diabetes and
heart disease, or treating these complications
Educating patients about how to modify their
dietary habits to maximize the effectiveness of
medical and pharmacologic treatments
Tailoring nutritional recommendations to fit
patients’ lifestyles and financial resources
Counseling patients to promote nutrition self-care
using available resources
Providing nutritional support to patients may help to
do the following:
♦
♦
♦
♦
Treat common problems associated with HIV
disease and its treatment (eg, weight loss,
wasting, fatigue, loss of appetite, adverse changes
in taste, dental problems, gastrointestinal
complaints)
Treat chronic comorbid conditions (eg,
cardiovascular disease, hypertension, diabetes,
cirrhosis)
Improve quality of life
Enhance immune responses, slow disease
progression, and prolong life