MNT for HIV and AIDS Flashcards
____ million people are living with HIV worldwide
38.4
There are ____ million new cases per year worldwide
1.5
In 2021, there were ____ deaths from HIV/AIDS
650,000
Where is there the highest prevalence of HIV/AIDS?
Africa
In the U.S, there are ____ people living with HIV infection (2019)
1,189,700
In 2020, there were ___ new cases of HIV infection in the US
30,635
In 2020, there were ____ deaths from HIV/AIDS in the US
18,489
HIV/AIDS is more common in what sex?
Males
What race has a higher prevalence of HIV/AIDS in the US?
Black Americans
HIV/AIDS is caused by a primary infection with the ___ ____ ____
Human Immunodeficiency Virus
HIV is a ____, which is an enveloped RNA virus that replicates using the enzyme reverse transcriptase to copy RNA into DNA
Retrovirus
HIV invades the genetic core of the ___ ___ ___ cells and replicates
CD4+ T-helper lymphocyte
HIV infection causes a progressive depeletion of CD4+ cells which causes _____
Immunodeficiency
What are possible transmission vehicles of HIV?
-Blood
-Semen
-Vaginal secretions
-Breast milik
The most common methods of transmission is through ___ ___
Sexual contact
Another common method of transmission is sharing contaminated ___, or injection of or contact with contaminated blood products
Needles
HIV can also be spread ____, which means in utero, during birth, or during breast feeding
Perinatal
To diagnose HIV, ___ ____ is done and the window period is up to 3 months
Antibody testing
The two main biomarkers used to assess disease progression are…
-CD4+ T-cell count
-Viral load
____ HIV infection is the period from the transmission to the host until the production of detectable antibodies against the virus (seroconversion)
Acute
Initial symptoms of seroconversion (acute HIV)
-Fever
-Malaise
-Pharyngitis
-Mylagia
-Swollen lymph glands
Initial symptoms occur within ___-___ weeks of infection
2-4
Initial symptoms last for ___-___ weeks
1-2
The acute HIV period has rapid viral replication prior to the development of an HIV-specific ___ ___
Immune response
HIV is highly ____ during seroconversion/acute HIV
Infectious
___ ___ is also known as asymptomatic HIV infection
Clinical latency
During clinical latency, the virus is active and replicating but at a ____ rate than during the acute stage
Lower
During clinical latency, ___ counts steadily decline
CD4+
In clinical latency, CD4+ counts are still above ____ cells/mm3
500
Characteristics of clinical latency:
-Persistent generalized lymphadenopathy
-Dermatological symptoms: seborrheic dermatitis
The clinical latency period of HIV may last up to ___ ____
10 years
In symptomatic HIV infection, CD4+ count is below ___ cells/mm3
500
During the symptomatic HIV infection, there is reduced ___-___ ____
Cell-mediated immunity
Symptoms of the symptomatic phase of HIV infection:
-Persistent fever
-Chronic diarrhea
-Unintentional weight loss
-Recurrent fungal, bacterial, or viral infections
Manifestations of the symptomatic phase of HIV infection:
-Oral candidiasis
-Oral hairy leukoplakia
-Herpes zoster
AIDS is diagnosed when there is HIV infection along with a CD4+ cell count of under ____ cells/mm3; or a documentation of an AIDS-defining conditions
200
Those with AIDS are highly susceptible to ___ ___
Opportunistic infections
What are some opportunist infections that are common in someone with AIDS?
-Pneumocystis jiroveci pneumonia
-Cytomegalovirus (CMV)
-Cryptosporidiosis
-Tuberculosis
What are other manifestations of AIDS?
-Kaposi’s sarcoma
-Lymphoma
-HIV-associated encephalopathy
-HIV-associated wasting
-Direct organ damage
Kaposi’s sarcoma is cancer of the ___ and ___ ____
Lymphatic and vascular endothelium
Clinical manifestations of Kaposi’s sarcoma:
-Purple nodules on the skin, mucous membranes, lymph nodes, or throughout the GIT
-Lesions in the oral cavity or esophagus-> painful swallowing and/or dysphagia
-GIT-> diarrhea or intestinal obstruction
What types of drug therapy are used for HIV/AIDS?
-Antiretroviral therapy (ART)
-Drugs used for complications
-Consider side effects and food-drug interactions
Antiretroviral drugs act to suppress the ____ of HIV
Replication
Antiretroviral therapy is a combination of ____ antiretroviral agents
3
Antiretroviral therapy reduced concentrations of the virus in the blood to decrease rates of ___ ____ and increase survival time
Opportunistic infections
___ ___ ___ ___ block the virus’s replication mechanism
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
One example of an NRTI is ____
Zidovudine (Retrovir)
Side effects of NRTIs:
-Anorexia
-Nausea
-Diarrhea
-Anemia
What is a food-drug interaction with NRTIs?
High fat foods (40 g) decrease drug absorption
Non-nucleoside Reverse Transcriptase Inhibitors block the virus’s ___ ___
Replication mechanism
An example of a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) is ____
Nevirapine (Viramune)
Side effects of Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) like Nevieapine:
-N/V
-Stomatitis
-Diarrhea
-Hepatotoxic
If taking Nevirapine (viramune), avoid ___ ____ ___ because it induces enzyme systems leading to increased metabolism of nevirapine, leading to lower serum levels
St. John’s Wort
___ ___ inhibit protease enzyme which HIV cells need to develop and mature
Protease Inhibitors
An example of a protease inhibitor is ____
Indinavir (Crixivan)
Side effects of protease inhibitors like indinavir include…
-Nausea
-Metallic taste
-Diarrhea
-Hyperglycemia
-Hyperlipidemia
-Lipodystrophy syndrome
Lipodystrophy syndrome causes increased abnormal fat deposition on the back of the ___ and the ___; causes altered lipid metabolism
Neck, abdomen
One example of a protease inhibitor is ____
Indinavir (Crixivan)
Food drug interactions with indinavir (protease inhibitor):
-Avoid St. John’s Wort (increases metabolism of a drug which decreases serum levels)
-Avoid grapefruit and grapefruit juice (both compete for cytochrome P450 enzymes and therefore can result in increased or decreased drug levels)
Challenges with antiretroviral therapy:
-Adherence (complicated regimens, side effects, cost)
-Drug resistance
Other medications that may be used for HIV/AIDS:
-Antifungal (Amphotericin B)
-Antibiotics
-Antiprotozoal (Pentamidine)
-Antiviral (Acyclovir)
-Isoniazid (INH)
Food drug interactions with Isoniazid:
Causes decreased vitamin B6 levels, so prescribe pyridoxal 5-phosphate supplementation of 25-50 mg/d
HIV-associated ___ ___ causes unintentional weight loss and loss of lean body mass
Wasting syndrome
The CDC definition of HIV-associated Wasting Syndrome is…
10+% weight loss from baseline in a 6-month period accompanied by diarrhea for 30+ days or chronic weakness and fever for 30+ days in the absence of a concurrent illness or infection
Cycle of illness with AIDS:
-Decreased intake, malabsorption, and increased caloric needs
-Malnutrition
-Tissue mass depletion and muscle wasting
0Increased susceptibility to infection
-Increased vulnerability to treatment-related toxicities
-Increased weakness, decreased well being (then leads back to decreased intake)
Malnutrition causes decreased ___ ___
Immune function
Malnutrition may cause what types of deficiencies that interfere with immune function?
-Protein
-EFA
-Vitamin A, C, D, E, zinc, selenium
Malnutrition may allow for more numerous and more severe ___ ___
Opportunistic infections
Malnutrition may also lead to reduced response to ____, as well as decreased quality of life and decreased longevity
Treatment
Causes of malnutrition and wasting:
-Inadequate oral intake
-GI tract disorders, infections, and malabsorption
-Increased metabolic rate
-Lack of physical activity
-Alcohol use
Decreased oral intake may be due to…
-Anorexia: meds or illness
-GI distress
-Fatigue
-Dysgeusia due to meds, xerostomia, or oral candidiasis
-Depression
-Dyspnea
-Neurologic disease due to altered mental status
-Food insecurity
-Disorders of the oral cavity and esophagus due to soreness of the mouth and tongue, difficulty chewing, odynophagia, dysphagia
Disorders of the oral cavity and esophagus include…
-Oral candidiasis
-Tumors, lesions, Kaposi’s sarcoma
The ___ ___ is one of the most common systems affected by HIV
Gastrointestinal tract
What are some GI manifestations of HIV/AIDS?
-Diarrhea (most common symptom)
-N/V
-Abdominal pain
-Malabsorption
Causes of diarrhea:
-Medications
-Intestinal pathogens
-Kaposi’s Sarcoma
-Lactose intolerance
-Fat malabsorption
What intestinal pathogens and neoplasms are common in HIV/AIDS?
-Cytomegalovirus
-Cryptosporidiosis
-Mycobacterium avium complex (MAC)
-Neoplasms like GI kaposi’s sarcoma and lymphomas
-HIV-enteropathy
Causes of intestinal pathogens and neoplasms:
-Diarrhea
-Enteritis
-Colitis
-GI bleeding
-Malabsorptioin
-Obstruction
Infections of the small intestine can cause malabsorption of…
-Fat (steatorrhea)
-Fat-soluble vitamins
-Protein
-Vitamin B12
-Minerals
Infection of the large intestine may cause malabsorption of ___ and ___
Water and electrolytes
Nutrition assessment should include past diagnosis and medical history, which includes…
-Current medical status (stage of disease, symptoms, opportunistic infections)
-Presence of pre-co-existing illnesses (DM, CHD, renal disease, liver disease)
-Metabolic issues like dyslipidemia
-Current plan of treatment
-Medications
NFPE and anthropometry should include…
-Anthropometric data (Ht, Wt, %IBW, % weight change over time, BMI; TSF, MAMC to assess fat and lean body stores)
-Muscle and fat wasting
-Functional status
-HIV-associated lipodystrophy syndrome (HALS)
HIV-associated lipodystrophy syndrome (HALS) is a syndrome associated with ___ ___ changes and ___ ___
Body shape; metabolic abnormalities
What types of body shape changes are associated with HALS?
-Fat deposition in the abdominal area, around the organs, and on the back of the neck
What metabolic abnormalities are associated with HALS?
-High TG and LDL cholesterol
-Low HDL cholesterol
The cause of HALS is multifactorial and includes…
-Duration of HIV infection
-Duration and type of ART medications
What biochemical data should be checked in someone with HIV/AIDS?
-Electrolytes
-BUN, creatinine
-FPG
-LFT’s
-CBC
-Lipid profile
-CD4 count
-Viral load
What psychosocial and economic issues should be asked about in nutrition assessment?
-Living arrangements
-Social/family support
-Financial resources
-Educational background and health literacy
-Substance abuse
-Depression, anxiety
-Food insecurity
Nutrition history should include…
-Usual food intake
-Weight history
-GI status; chewing and swallowing ability
-Food allergies and intolerances
-Alcohol and caffeine intake
-Ability to prepare meals
-Available cooking/shopping facilities
-Exercise
-Supplement use
-Use of complementary or alternative therapies
Considerations for complementary/integrative and alternative therapies:
-Effectiveness
-Is the treatment harmful?
-Are there any potential interactions with drugs or nutrients?
-Is the use of effective conventional therapies being prevented or delayed?
-Expense?
St. John’s Wort and concentrated garlic supplements can decrease serum levels of some ___ ___
Protease inhibitors
Probiotic supplements are commonly used for ___ and ___ ___
Diarrhea and gut dysbiosis
There is a lack of accurate predictive equations for predicting ___ ___ for people with HIV/AIDS
Energy needs
We should ____ energy need requirements and consider weight and nutrition status, severity of disease, opportunistic infections, and comorbidities
Individualize
REE might be ___ in people with HIV/AIDS compared to those without HIV/AIDS
Higher
With asymptomatic HIV, REE might be increased by ___%
10
If someone with HIV/AIDS has an opportunistic infection, their REE may increase by ___-___%
20-50
What factors may increase protein needs?
-Infection
-Healing
-Protein malnutrition
-Protein-losing enteropathy
-Comorbidities
Protein needs for someone with asymptomatic HIV:
1.0-1.4 g/kg BW
Protein needs for symptomatic patients:
1.5-2 g/kg BW
Fat needs should be ____
Individualized
Use the ___ for percent kcal from fat and saturated fatty acids
DRI
For individuals with hyperlipidemia or other CVD risk factors, recommend a ___ ____ diet
Heart healthy
If someone has fat malabsorption, prescribe a ___ gram low fat diet
40
Monitor people for potential micronutrient deficiencies due to…
-GI losses; malabsorption
-Inadequate diet
-Altered metabolism
-Food-drug interactions
What are specific nutrients of concern?
-Vitamin B12
-Vitamin A
-Vitamin E
-Vitamin D
-Selenium
-Zinc
-Iron
We should provide a ___ with minerals (100% DRI’s) if dietary intake is inadequate
MVI
We should ____ fluid and electrolyte needs
Individualize
What factors increase fluid requirements/might require replacement of electrolytes?
-Fever
-Vomiting
-Diarrhea
What are the goals of MNT for those with HIV/AIDS?
-Optimize nutritional status and immune function
-Maintain a healthy BW and LMB
-Prevent nutritional deficiencies
-Reduce the risk of comorbidities or treat/manage comorbidities
-Maximize the effectiveness of pharmacologic treatment
-Enhance quality of life
Goals of nutrition education for someone with HIV/AIDS:
-Educate on importance of nutrition and maintaining adequate nutritional status
-Well-balanced, high-protein diet
-Emphasize regular physical activity
-Therapeutic diets as needed
-Symptom management
-Food-medication interactions
-Food safety precautions to prevent food-borne illness
What are examples of food safety precautions that people with HIV/AIDS should use?
-Avoid raw protein foods and raw meat
-Avoid using cracked eggs
-Thaw perishable foods in the fridge
-Wash raw fruits and vegetables thoroughly
-Use only pasteurize milk
-Cook to appropriate temperatures
-Store food at appropriate temperatures
-Adhere to the expiration dates on labels
-Wash hands before handling food
How should we go about improving inadequate intake in people with HIV/AIDS?
-Obtain food preferences
-Prescribe small, frequent meals
-Focus on nutrient-dense foods
-Concentrate intake at time of day when appetite is best and in a pleasant environment
-Oral nutrition supplements
-Take advantage of home-delivered meals
-Rx MVI with minerals supplement
-Consider recommending MD to order appetite stimulants
-May require enteral nutrition
MNT for oral or esophageal inflammation or lesions:
-Soft, moist foods
-Avoid highly seasoned and acidic foods and beverages
-Avoid hard and salty foods
-Avoid temperature extremes
-Provide straws for drinking
-Avoid dry foods
-Drink liquids with meals
-Popsicles to numb mouth
MNT for dysgeusia:
-Food preferences
-Cold foods
-Drink fluids with meals
-Experiment with flavors and seasonings
-Alternative sources of protein
-Avoid canned foods or canned oral supplements
-Good mouth care
MNT for diarrhea:
-Adequate hydration and electrolytes
-Small, frequent meals
-Limit insoluble fiber and increase soluble fiber
-Limit intake sorbitol, caffeine, alcohol
-Avoid high-fat foods and spicy foods
-Low lactose diet if needed
-Reduce intake of sugars
If someone has HIV-associated Lipodystrophy Syndrome (HALS), they should follow the American College of Cardiology/American Heart Association Guidelines to…
-Reduce intake of saturated fat to 5-6% of total kcal
-Reduce trans-fat to as little as possible
-Increase soluble fiber
-Include omega-3 fatty acids
-Increase physical activity
We may consider ___ ___ when a patient cannot consume adequate nutrition orally
Enteral Nutrition
Tube placement considerations:
-Duration of therapy
-GI function
-Avoid nasogastric tubes if painful esophageal lesions
For enteral nutrition, use ___ ___, polymeric formulas
High protein
If someone has fat malabsorption, use ___-___ formulas
Semi-elemental
What is an indication of parenteral nutrition?
Severe GI dysfunction
With parenteral nutrition, there is increased ____ risk, so we must consider risk vs benefits
Infection
