MNT for HIV Disease PDF

MNT for HIV Disease MNT for HIV Disease From Krause and Mahan’s Food & the Nutrition Care Process Allison Charny, MS, RDN, CDCES, CDN HIV and AIDS ⚫ Many nutritional problems associated with HIV/AIDS such as ⚫ weight loss ⚫ malnutrition ⚫ Malnutrition and HIV/AIDS affect imm...

MNT for HIV Disease MNT for HIV Disease From Krause and Mahan’s Food & the Nutrition Care Process Allison Charny, MS, RDN, CDCES, CDN HIV and AIDS ⚫ Many nutritional problems associated with HIV/AIDS such as ⚫ weight loss ⚫ malnutrition ⚫ Malnutrition and HIV/AIDS affect immune function – together have an additive effect on immunosuppression HIV / AIDS Etiology ⚫ Viral origin ⚫ Opportunistic infections (OIs) first described in 1981 in US ⚫ PCP, CMV, candidiasis, KS with severe immunosuppression ⚫ In 1983 etiology of OIs was identified as HIV HIV/AIDS Definition HIV+ ⚫ Antibodies to HIV; previously infected ⚫ AIDS ⚫ HIV infection with symptoms and at least one HIV linked clinical condition HIV / AIDS Epidemiology ⚫ 1.2 million people living with HIV/AIDS in US; ~35 million world-wide ⚫ ~ 10-15% undiagnosed ⚫ ~ 70-80% male ⚫ Those infected… primary transmission in men: men having sex with men; women: heterosexual transmission; IV drug users Transmission ⚫ HIV resides in blood, semen, vaginal secretions, lymph and CNS ⚫ HIV transmitted via body fluids: blood, semen, pre-seminal fluid, vaginal secretions, and breast milk ⚫ Modes of HIV transmission: sexual contact, shared needles, contaminated blood products, across placenta, birth, and breastfeeding Pathology HIV Reproduction Pathology ⚫ Body mounts immune response (basis for HIV testing) ⚫ Depletion of CD4 cells occurs ⚫ Immunocompromise, secondary infections, and neoplasms Viral Load and CD4 Count ⚫ ↑ circulating viral RNA (viral load) = ↑ CD4 cells destroyed = rapid progression to AIDS ⚫ As viral load ↑ the CD4 count ↓ ⚫ Viral load reference range: ⚫ < 100,000 copies / ml ⚫ CD4 reference range: ⚫ > 350 / ml Viral Course / Stages of Infection ⚫ Acute (CD4 ↓ then ↑) ⚫ 2-4 weeks after transmission: mono-like symptoms, high viral load, highly infectious ⚫ Seroconversion 1 week to few months (+ HIV test) ⚫ Asymptomatic (latency; CD4 gradual ↓) ⚫ Up to 10 years after infection ⚫ Subclinical changes: decrease in LBM, increased foodborne illness ⚫ Symptomatic (CD4 < 500) ⚫ Infections, diarrhea, fever, fatigue, wt loss, decline in nutrient status ⚫ AIDS (CD4 < 200 or AIDS defining condition; Box 36-1) ⚫ OIs and conditions due to severe immunodeficiency Manifestations within Body Systems (T 36-2) Note effects on nutrition! ⚫ Cancer: KS ⚫ Neurologic Disease: HIV AND opportunistic infect the CNS (AIDS dementia) ⚫ Liver disease: HCV ⚫ Lung Disease: mycobacterium tuberculosis; PCP, PJP, TB ⚫ Nephropathy: infections ⚫ GI: candidiasis, herpes, CMV, cryptosporidiosis, AIDS enteropathy ⚫ Other affected organs: lymph nodes, bone marrow, eyes Medications Antiretroviral Therapy (ART) ⚫ Combinations of antiretroviral drugs based on viral load, CD4, conditions, life stage ⚫ 6 mechanistic classes ⚫ NRTIs ⚫ NNRTIs ⚫ PIs ⚫ Fusion Inhibitors ⚫ CCR5 ⚫ INSTIs RD need to address timing of meals; nutrition effects Medications (T 36-1) Antiretroviral Therapy (ART) ⚫ Side Effects ⚫ Viral resistance ⚫ Complicated drug schedules ⚫ Poor drug tolerance ⚫ Adverse effects on liver, pancreas, kidney, bone marrow, bone ⚫ Lipodystrophy syndrome ⚫ abnormal glucose and lipid metabolism (↑CVD) ⚫ central obesity, peripheral fat wasting, dorsocervical fat accumulation ART - Central Obesity ART - Peripheral Fat Wasting ART - Dorsocervical Fat Malnutrition and AIDS ⚫ HIV wasting syndrome (Box 36-1) ⚫ Diagnostic of AIDS ⚫ Defined as: ⚫ Unintentional weight loss > 10% ⚫ + diarrhea or fever and weakness w/o illness ⚫ Related to multiple factors: ⚫ Low intake, malabsorption, altered metabolism, infections, cytokines ⚫ Indicators: Loss of LBM, BMI < 18.5,