Ch 32: HIV Infection

Question 1

Where is HIV found in the body?

Answer 1

In all body fluids except urine and sweat; seminal fluids and blood are the most infectious. Transmission occurs when uninfected host comes into contact w/ semen, blood, or blood tinged body fluids

Question 2

How is acute HIV infection is marked?

Answer 2

Byrapid/severe loss of memory CD4+/CCR5+ T lymphocytes in gastrointestinal tissue

Question 3

What factor leads to increased risk of opportunistic infections or AIDS defining malignancies?

Answer 3

Progressive loss of CD4+ T lymphocytes following establishment of infection.

Question 4

When is a diagnosis of AIDS is made?

Answer 4

When HIV infected person has CD4 count less then 200 cells/mm or a CD4 percentage less than 14% or is diagnosed with wasting syndrome or other AIDs defining illness

Question 5

What is the goal of cART?

Answer 5

To facilitate reconstitution of CD4 + T lymphocytes by long term suppression of viral replication

Question 6

Which noninfectious commodities are now predominant in HIV medicine?

Answer 6

CVD, osteopenia/osteoporosis, and sarcopenia/frailty

Prior to advent of cART, wasting disease was the prominent nutrition related issue in patients receiving care in high income nations

Question 7

______ is predictive of opportunistic infection, poor outcome, or morality in patients initiating cART

Answer 7

Wasting syndrome

Question 8

What distinguishes HIV infected patient experiencing undernutrition from an uninfected patient experiencing the same?

Answer 8

Inability to mount compensatory metabolic response to undernutrition b/c of viral effect on metabolism

Question 9

What are some maladaptive metabolic abnormalities in HIV infected patient experiencing undernutrition ?

Answer 9

Increased resting REE, inappropriate substrate use, and futile cycling of lipids

Question 10

What is the proximate predictor and drive of wasting disease?

Answer 10

Prolonged decrease in energy intake

Question 11

What can help distinguish wasting from lipodystrophy syndrome?

Answer 11

Waist circumference and waist to hip ratio can help distinguish wasting from lipodystrophy syndrome b/c patient with wasting is unlikely to experience isolated fat loss in the face, extremities, and buttocks w/out significant fat loss

Question 12

What is Megestrol acetate (Megace or Megace ES oral suspension) and how is it used in AIDS wasting?

Answer 12

It is a synthetic progestin, related to progesterone, that has been shown to create sensation of hunger and promote weight gain in patients with AIDS wasting

Question 13

What is Dronabinol, and how is it used in AIDS treatment?

Answer 13

Dronabinol (Marinol) is the active component of marijuana and is approved for treatment of anorexia in
AID pt’s

Not a potent as megestrol acetate but does have mild antiemetic activity and a more benign side effect profile.

It has NOT been shown to consistently increase food intake or promote weight gain. Side effects include psychotropic activity, drowsiness, and hypogonadism

Question 14

What are some treatments used to increase LBM in AIDS?

Answer 14

Recombinant Human Growth Hormone (may cause hyperglycemia/edema) Anabolic-Androgenic Steroids (in men), and resistance exercise

Question 15

Which predicative equation is most widely referenced in the literature and is useful when working without IC for patients diagnosed with HIV/AIDS?

Answer 15

Harris Benedict

Question 16

In HIV patients requiring EN, what type of TF formula should be selected?

Answer 16

Standard formula; HIV infected patients receiving arginine and omega 3 FA enriched formula compared to standard formula did not demonstrate superior anthropometric or immunologic parameters

Question 17

Loss of gastric wall mass in HIV infected patient w/ wasting with feeding tube may contribute to what?

Answer 17

Risk of buried bumper syndrome; this setting requires endoscopic evaluation

Question 18

In which cases should PN be considered for a patient diagnosed with HIV/AIDS?

Answer 18

Patients with extensive small bowel disease such as jejunoileitis are candidates for PN; these patients frequently demonstrate panmalabsoprtion w/ volume of diarrhea directly related to food intake by mouth

Question 19

In HIV, what is a clinical consequence of osteoporosis?

Answer 19

Fragility fracture; incidence of fragility fractures is higher in midlife and older HIV infected male/female participants compared to those not infected

Question 20

How are osteoporosis and osteopenia defined?

Answer 20

By T score; comparison of bone density of a patient 50 years or older to that of a 25-35-year-old gender and ethnicity matched reference population

T score -2.5 standard deviations (SD) in a subject age 50 or older is considered osteoporotic

A T score of -1.0 SD is considered osteopenia

Question 21

What factors are associated w/ risk for BMD loss in HIV patients?

Answer 21

male sex, current PI containing regimen, low weight or BMI. Other factors include hep C or B co infection, low CD4 count, prior AIDS, male hypogonadism and substance use

Question 22

How should osteoporosis be managed for HIV patient?

Answer 22

• Interventions include vit D supplementation in people w/ documented deficiency or insufficiency
• Calcium, preferably from food sources (1000 mg for men to age 70 and women age 50; 1200 mg day for men 71 and older and women 51 and older)
• Review of dietary protein intake should be done, and sodium should be reduced
• Cessation of tobacco and rec substance use should also receive attention
• Routine schedule exercise may be preventative

Question 23

What is the central feature of lipodystrophy in HIV patients?

Answer 23

Selective and persisting subcutaneous adipose tissue loss. Visceral adipose tissue is spared

Lipodystrophy loss of tissue may be focal or generalized (face only, facial and gluteal femoral or head, trunk and limbs). Most frequently affected areas are face, buttocks, thighs, and lastly upper arms

Lipodystrophy was strongly associated w/ first generation cART, and decreased used of these meds has declined

Question 24

What is a major cause of morbidity and mortality in HIV infected adults > 50 years?

Answer 24

AMI/CVD; Natural history of HIV infection is marked by proatherogenic lipid and lipoprotein changes. Progressive HIV (AIDS) may be accompanied by increases in serum TG and VLDL-C. These proatherogenic changes in lipids/lipoproteins have been associated w/ increasing HIV RNA levels and decreasing CD4 + T cell count

Question 25

Which type of diet has demonstrated efficacy in primary/secondary prevention trials in individuals without known HIV infection?

Answer 25

The Mediterranean diet; In community dwelling HIV infected patient receiving cART, adherence to Mediterranean diet was associated w/ better metabolic parameters and lower risk for abdominal adiposity vs a typical western diet

Question 26

Human immunodeficiency virus (HIV) associated lipodystrophy syndrome is most commonly associated with which of the following classes of agents used to treat HIV infection?

Answer 26

Nucleoside reverse transcriptase inhibitors (NRTIs).