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2–8 | Clinical Manual for Management of the HIV-Infected Adult/2006 Body Composition Testing Body composition is commonly tested by bioelectrical impedance analysis (Table 5) or skinfold thickness and cirumference (Table 6). Table 5. Bioelectrical Impedance Analysis Bioelectrical impedance analysis (BIA) testing is the standard of care for adults but has not been well validated for children: • BIA is useful for assessing disease progression or health maintenance, documenting response to treatment, and justifying the cost of nutritional supplements and AIDS-wasting medications. • The test is simple, noninvasive, and quick (
♦ ♦ Nutrient losses (eg, due to diarrhea, vomiting) Potential confounding factors (eg, use of multiple overlapping or questionable supplements) Evaluate Dietary Intake Assess the following diet-related issues: ♦ ♦ ♦ ♦ Expected excesses or deficiencies from dietary history or interview Rating of food security, including access to cooking and refrigeration Food intolerances, aversions, or allergies likely to affect adequacy of intake Special needs related to other conditions (eg, documented cardiovascular disease, diabetes, hypertension) Evaluate Weight, Body Composition, and Weight Distribution Assess physical findings of malnutrition and confirm with nutrition history, laboratory tests, and anthropometric evidence. Table 7 describes normal and abnormal findings of anthropometric tests and recommendations for monitoring changes over time. Table 7. Evaluating the Findings of Anthropometric Tests Monitoring Trends and Recommendations Adults • Chart trends over time relative to previous • • • • measurements and the following population norms: BMI (healthy range: 19-25) BIA: • • • BCM (% of weight): women 30-35%; men: 40-45% Fat (% of weight): women 20-30%; men 15-25% Phase angle: women >5; men >6 Skinfold thicknesses and circumferences: Chart changes in absolute measures and percentiles Changes in body contours: Evaluate lipodystrophy (excess accumulation of fat in abdomen, breasts, dorsocervical area) and lipoatrophy (loss of subcutaneous fat in face, extremities, buttocks) Children • Plot measurements on growth charts and track percentiles over time (the consistency of percentiles rather than the absolute percentile is important) • Skinfold thicknesses and circumferences: Chart changes in absolute measures and percentiles Key to abbreviations: BMI = body mass index; BIA = bioelectrical impedance analysis; BCM = body cell mass. Section 2—Health Maintenance and Disease Prevention | 2–9 Evaluate Laboratory Findings ♦ ♦ Evidence of malnutrition (eg, low iron or protein stores) Evidence of disease or risk of disease for which dietary treatment is indicated (eg, high fasting glucose, hypertension, hyperlipidemia) Develop a Problem List Table 8 suggests a useful format for a nutrition-related problem list. Table 8. Nutrition-Related Problem List Format Problem # Description of Problem (circle/describe) Nutrition barriers: insufficient knowledge, poor appetite, food insecurity, no food preparation or storage facilities, homelessness Lifestyle: substance abuse, smoking, erratic eating, frequent fast-food intake, high stress Weight or body composition: undesirable weight gain or loss (adult), changes in growth trajectory (children), loss of lean body mass (wasting), gain of excess fat (obesity), lipoatrophy or lipodystrophy Physical problems: fatigue, pain, early satiety, poor dentition, clinical signs of malnutrition Laboratory findings: low hematocrit or hemoglobin, low protein or albumin, low or high fasting glucose, high total cholesterol, high low-density lipoprotein, high triglycerides, low high-density lipoprotein, low testosterone Gastrointestinal: diarrhea, vomiting, reflux, constipation Poor diet: poor food choices, bingeing, skipping meals, high sugar intake, high alcohol consumption, high intake of refined foods, low fruit and vegetable intake, insufficient protein, insufficient calcium, food allergies or intolerances limiting intake Comorbid conditions: diabetes, hypertension, cardiovascular disease, cancer, gastroesophageal reflux disease (GERD) Medications: drug-drug or drug-nutrient interactions or difficulty coordinating medicines with meals Supplements: insufficient or excessive intakes, cost of supplements unaffordable, supplements with potential or unknown risks
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Clinical Manual for Management of t
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Table of Contents Clinical Manual f
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Clinical Manual for Management of t
Page 7 and 8: Preface—About this Manual | Clini
Page 9: Previous Editions Atlanta Contribut
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Page 23 and 24: Initial Physical Examination Backgr
Page 25 and 26: Genitals/Rectum • Inspect the gen
Page 27 and 28: Initial and Interim Laboratory and
Page 29 and 30: Section 1—Testing and Assessment
Page 31: Patient Education ♦ ♦ ♦ ♦ D
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Page 51 and 52: Section 2—Health Maintenance and
Page 53: References ♦ ♦ ♦ ♦ ♦ ♦
Page 67 and 68: Occupational Postexposure Prophylax
Page 69 and 70: P: Plan Laboratory Testing Provide
Page 71 and 72: For hepatitis C, no recommended pro
Page 75 and 76: as hepatitis C or another sexually
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Page 81 and 82: contact with the patient. Patients
Page 83 and 84: tablet daily of trimethoprim-sulfam
Page 85 and 86: Opportunistic Infection Prophylaxis
Page 87 and 88: Discontinuing Primary Prophylaxis P
Page 89 and 90: Latent Tuberculosis Background Late
Page 91 and 92: INH may cause liver toxicity and it
Page 93: Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Patient Education ♦ ♦ ♦ ♦
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Section 4—Complications of Antire
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♦ ♦ ♦ Toronto General Hospita
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Adverse Reactions to HIV Medication
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♦ ♦ ♦ ♦ ♦ Vital signs: No
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egimen, symptoms of fatigue could i
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Recreational Drugs and Antiretrovir
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Section 4—Complications of Antire
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LSD, Mescaline, Psilocin, and Methy
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Immune Reconstitution Syndrome Back
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A: Assessment In the appropriate cl
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♦ ♦ ♦ ♦ ♦ Navas E, Martin
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Eye Problems Background The immunos
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of
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Fever Background Although fever may
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Headache Background Headache may ha
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Lymphadenopathy Background Lymphade
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Treatment Treatment will depend on
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Neurologic Symptoms Background The
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♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
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Pulmonary Symptoms Background Short
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Treatment Once the diagnosis is mad
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Candidiasis, Oral and Esophageal Ba
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Maintenance therapy Use caution whe
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Cervical Dysplasia Background Cervi
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Patient Education ♦ ♦ ♦ ♦ P
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Cryptosporidiosis Background Crypto
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Gonorrhea and Chlamydia Background
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Treatment of Gonorrhea Treatment op
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Hepatitis B Infection Background He
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♦ ♦ ♦ ♦ ♦ Some patients t
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Hepatitis C Infection Background He
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pregnancy. Ribavirin is teratogenic
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Herpes Simplex, Mucocutaneous Backg
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References ♦ ♦ ♦ ♦ ♦ Cent
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Kaposi Sarcoma Background Kaposi sa
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Treatment Treatment of KS is not co
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Molluscum Contagiosum Background Mo
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Mycobacterium avium Complex Backgro
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Table 1. Interactions between Rifab
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Mycobacterium tuberculosis: Treatme
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P: Plan Diagnostic Evaluation Durin
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Table 1. Regimens for Treatment of
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Rifabutin may be substituted for ri
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Non-Hodgkin Lymphoma Background Non
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Patient Education ♦ ♦ ♦ ♦ S
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Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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