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Advanced Medical Nutrition Therapy > MNT for HIV and AIDS > Flashcards

MNT for HIV and AIDS Flashcards

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USMLE® Step 1 flashcards
1
Q

____ million people are living with HIV worldwide

A

38.4

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2
Q

There are ____ million new cases per year worldwide

A

1.5

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3
Q

In 2021, there were ____ deaths from HIV/AIDS

A

650,000

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4
Q

Where is there the highest prevalence of HIV/AIDS?

A

Africa

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5
Q

In the U.S, there are ____ people living with HIV infection (2019)

A

1,189,700

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6
Q

In 2020, there were ___ new cases of HIV infection in the US

A

30,635

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7
Q

In 2020, there were ____ deaths from HIV/AIDS in the US

A

18,489

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8
Q

HIV/AIDS is more common in what sex?

A

Males

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9
Q

What race has a higher prevalence of HIV/AIDS in the US?

A

Black Americans

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10
Q

HIV/AIDS is caused by a primary infection with the ___ ____ ____

A

Human Immunodeficiency Virus

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11
Q

HIV is a ____, which is an enveloped RNA virus that replicates using the enzyme reverse transcriptase to copy RNA into DNA

A

Retrovirus

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12
Q

HIV invades the genetic core of the ___ ___ ___ cells and replicates

A

CD4+ T-helper lymphocyte

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13
Q

HIV infection causes a progressive depeletion of CD4+ cells which causes _____

A

Immunodeficiency

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14
Q

What are possible transmission vehicles of HIV?

A

-Blood
-Semen
-Vaginal secretions
-Breast milik

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15
Q

The most common methods of transmission is through ___ ___

A

Sexual contact

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16
Q

Another common method of transmission is sharing contaminated ___, or injection of or contact with contaminated blood products

A

Needles

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17
Q

HIV can also be spread ____, which means in utero, during birth, or during breast feeding

A

Perinatal

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18
Q

To diagnose HIV, ___ ____ is done and the window period is up to 3 months

A

Antibody testing

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19
Q

The two main biomarkers used to assess disease progression are…

A

-CD4+ T-cell count
-Viral load

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20
Q

____ HIV infection is the period from the transmission to the host until the production of detectable antibodies against the virus (seroconversion)

A

Acute

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21
Q

Initial symptoms of seroconversion (acute HIV)

A

-Fever
-Malaise
-Pharyngitis
-Mylagia
-Swollen lymph glands

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22
Q

Initial symptoms occur within ___-___ weeks of infection

A

2-4

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23
Q

Initial symptoms last for ___-___ weeks

A

1-2

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24
Q

The acute HIV period has rapid viral replication prior to the development of an HIV-specific ___ ___

A

Immune response

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25
Q

HIV is highly ____ during seroconversion/acute HIV

A

Infectious

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26
Q

___ ___ is also known as asymptomatic HIV infection

A

Clinical latency

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27
Q

During clinical latency, the virus is active and replicating but at a ____ rate than during the acute stage

A

Lower

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28
Q

During clinical latency, ___ counts steadily decline

A

CD4+

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29
Q

In clinical latency, CD4+ counts are still above ____ cells/mm3

A

500

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30
Q

Characteristics of clinical latency:

A

-Persistent generalized lymphadenopathy
-Dermatological symptoms: seborrheic dermatitis

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31
Q

The clinical latency period of HIV may last up to ___ ____

A

10 years

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32
Q

In symptomatic HIV infection, CD4+ count is below ___ cells/mm3

A

500

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33
Q

During the symptomatic HIV infection, there is reduced ___-___ ____

A

Cell-mediated immunity

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34
Q

Symptoms of the symptomatic phase of HIV infection:

A

-Persistent fever
-Chronic diarrhea
-Unintentional weight loss
-Recurrent fungal, bacterial, or viral infections

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35
Q

Manifestations of the symptomatic phase of HIV infection:

A

-Oral candidiasis
-Oral hairy leukoplakia
-Herpes zoster

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36
Q

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

A

200

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37
Q

Those with AIDS are highly susceptible to ___ ___

A

Opportunistic infections

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38
Q

What are some opportunist infections that are common in someone with AIDS?

A

-Pneumocystis jiroveci pneumonia
-Cytomegalovirus (CMV)
-Cryptosporidiosis
-Tuberculosis

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39
Q

What are other manifestations of AIDS?

A

-Kaposi’s sarcoma
-Lymphoma
-HIV-associated encephalopathy
-HIV-associated wasting
-Direct organ damage

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40
Q

Kaposi’s sarcoma is cancer of the ___ and ___ ____

A

Lymphatic and vascular endothelium

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41
Q

Clinical manifestations of Kaposi’s sarcoma:

A

-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

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42
Q

What types of drug therapy are used for HIV/AIDS?

A

-Antiretroviral therapy (ART)
-Drugs used for complications
-Consider side effects and food-drug interactions

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43
Q

Antiretroviral drugs act to suppress the ____ of HIV

A

Replication

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44
Q

Antiretroviral therapy is a combination of ____ antiretroviral agents

A

3

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45
Q

Antiretroviral therapy reduced concentrations of the virus in the blood to decrease rates of ___ ____ and increase survival time

A

Opportunistic infections

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46
Q

___ ___ ___ ___ block the virus’s replication mechanism

A

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

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47
Q

One example of an NRTI is ____

A

Zidovudine (Retrovir)

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48
Q

Side effects of NRTIs:

A

-Anorexia
-Nausea
-Diarrhea
-Anemia

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49
Q

What is a food-drug interaction with NRTIs?

A

High fat foods (40 g) decrease drug absorption

50
Q

Non-nucleoside Reverse Transcriptase Inhibitors block the virus’s ___ ___

A

Replication mechanism

51
Q

An example of a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) is ____

A

Nevirapine (Viramune)

52
Q

Side effects of Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) like Nevieapine:

A

-N/V
-Stomatitis
-Diarrhea
-Hepatotoxic

53
Q

If taking Nevirapine (viramune), avoid ___ ____ ___ because it induces enzyme systems leading to increased metabolism of nevirapine, leading to lower serum levels

A

St. John’s Wort

54
Q

___ ___ inhibit protease enzyme which HIV cells need to develop and mature

A

Protease Inhibitors

55
Q

An example of a protease inhibitor is ____

A

Indinavir (Crixivan)

56
Q

Side effects of protease inhibitors like indinavir include…

A

-Nausea
-Metallic taste
-Diarrhea
-Hyperglycemia
-Hyperlipidemia
-Lipodystrophy syndrome

57
Q

Lipodystrophy syndrome causes increased abnormal fat deposition on the back of the ___ and the ___; causes altered lipid metabolism

A

Neck, abdomen

58
Q

One example of a protease inhibitor is ____

A

Indinavir (Crixivan)

59
Q

Food drug interactions with indinavir (protease inhibitor):

A

-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)

60
Q

Challenges with antiretroviral therapy:

A

-Adherence (complicated regimens, side effects, cost)
-Drug resistance

61
Q

Other medications that may be used for HIV/AIDS:

A

-Antifungal (Amphotericin B)
-Antibiotics
-Antiprotozoal (Pentamidine)
-Antiviral (Acyclovir)
-Isoniazid (INH)

62
Q

Food drug interactions with Isoniazid:

A

Causes decreased vitamin B6 levels, so prescribe pyridoxal 5-phosphate supplementation of 25-50 mg/d

63
Q

HIV-associated ___ ___ causes unintentional weight loss and loss of lean body mass

A

Wasting syndrome

64
Q

The CDC definition of HIV-associated Wasting Syndrome is…

A

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

65
Q

Cycle of illness with AIDS:

A

-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)

66
Q

Malnutrition causes decreased ___ ___

A

Immune function

67
Q

Malnutrition may cause what types of deficiencies that interfere with immune function?

A

-Protein
-EFA
-Vitamin A, C, D, E, zinc, selenium

68
Q

Malnutrition may allow for more numerous and more severe ___ ___

A

Opportunistic infections

69
Q

Malnutrition may also lead to reduced response to ____, as well as decreased quality of life and decreased longevity

A

Treatment

70
Q

Causes of malnutrition and wasting:

A

-Inadequate oral intake
-GI tract disorders, infections, and malabsorption
-Increased metabolic rate
-Lack of physical activity
-Alcohol use

71
Q

Decreased oral intake may be due to…

A

-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

72
Q

Disorders of the oral cavity and esophagus include…

A

-Oral candidiasis
-Tumors, lesions, Kaposi’s sarcoma

73
Q

The ___ ___ is one of the most common systems affected by HIV

A

Gastrointestinal tract

74
Q

What are some GI manifestations of HIV/AIDS?

A

-Diarrhea (most common symptom)
-N/V
-Abdominal pain
-Malabsorption

75
Q

Causes of diarrhea:

A

-Medications
-Intestinal pathogens
-Kaposi’s Sarcoma
-Lactose intolerance
-Fat malabsorption

76
Q

What intestinal pathogens and neoplasms are common in HIV/AIDS?

A

-Cytomegalovirus
-Cryptosporidiosis
-Mycobacterium avium complex (MAC)
-Neoplasms like GI kaposi’s sarcoma and lymphomas
-HIV-enteropathy

77
Q

Causes of intestinal pathogens and neoplasms:

A

-Diarrhea
-Enteritis
-Colitis
-GI bleeding
-Malabsorptioin
-Obstruction

78
Q

Infections of the small intestine can cause malabsorption of…

A

-Fat (steatorrhea)
-Fat-soluble vitamins
-Protein
-Vitamin B12
-Minerals

79
Q

Infection of the large intestine may cause malabsorption of ___ and ___

A

Water and electrolytes

80
Q

Nutrition assessment should include past diagnosis and medical history, which includes…

A

-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

81
Q

NFPE and anthropometry should include…

A

-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)

82
Q

HIV-associated lipodystrophy syndrome (HALS) is a syndrome associated with ___ ___ changes and ___ ___

A

Body shape; metabolic abnormalities

83
Q

What types of body shape changes are associated with HALS?

A

-Fat deposition in the abdominal area, around the organs, and on the back of the neck

84
Q

What metabolic abnormalities are associated with HALS?

A

-High TG and LDL cholesterol
-Low HDL cholesterol

85
Q

The cause of HALS is multifactorial and includes…

A

-Duration of HIV infection
-Duration and type of ART medications

86
Q

What biochemical data should be checked in someone with HIV/AIDS?

A

-Electrolytes
-BUN, creatinine
-FPG
-LFT’s
-CBC
-Lipid profile
-CD4 count
-Viral load

87
Q

What psychosocial and economic issues should be asked about in nutrition assessment?

A

-Living arrangements
-Social/family support
-Financial resources
-Educational background and health literacy
-Substance abuse
-Depression, anxiety
-Food insecurity

88
Q

Nutrition history should include…

A

-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

89
Q

Considerations for complementary/integrative and alternative therapies:

A

-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?

90
Q

St. John’s Wort and concentrated garlic supplements can decrease serum levels of some ___ ___

A

Protease inhibitors

91
Q

Probiotic supplements are commonly used for ___ and ___ ___

A

Diarrhea and gut dysbiosis

92
Q

There is a lack of accurate predictive equations for predicting ___ ___ for people with HIV/AIDS

A

Energy needs

93
Q

We should ____ energy need requirements and consider weight and nutrition status, severity of disease, opportunistic infections, and comorbidities

A

Individualize

94
Q

REE might be ___ in people with HIV/AIDS compared to those without HIV/AIDS

A

Higher

95
Q

With asymptomatic HIV, REE might be increased by ___%

A

10

96
Q

If someone with HIV/AIDS has an opportunistic infection, their REE may increase by ___-___%

A

20-50

97
Q

What factors may increase protein needs?

A

-Infection
-Healing
-Protein malnutrition
-Protein-losing enteropathy
-Comorbidities

98
Q

Protein needs for someone with asymptomatic HIV:

A

1.0-1.4 g/kg BW

99
Q

Protein needs for symptomatic patients:

A

1.5-2 g/kg BW

100
Q

Fat needs should be ____

A

Individualized

101
Q

Use the ___ for percent kcal from fat and saturated fatty acids

A

DRI

102
Q

For individuals with hyperlipidemia or other CVD risk factors, recommend a ___ ____ diet

A

Heart healthy

103
Q

If someone has fat malabsorption, prescribe a ___ gram low fat diet

A

40

104
Q

Monitor people for potential micronutrient deficiencies due to…

A

-GI losses; malabsorption
-Inadequate diet
-Altered metabolism
-Food-drug interactions

105
Q

What are specific nutrients of concern?

A

-Vitamin B12
-Vitamin A
-Vitamin E
-Vitamin D
-Selenium
-Zinc
-Iron

106
Q

We should provide a ___ with minerals (100% DRI’s) if dietary intake is inadequate

A

MVI

107
Q

We should ____ fluid and electrolyte needs

A

Individualize

108
Q

What factors increase fluid requirements/might require replacement of electrolytes?

A

-Fever
-Vomiting
-Diarrhea

109
Q

What are the goals of MNT for those with HIV/AIDS?

A

-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

110
Q

Goals of nutrition education for someone with HIV/AIDS:

A

-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

111
Q

What are examples of food safety precautions that people with HIV/AIDS should use?

A

-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

112
Q

How should we go about improving inadequate intake in people with HIV/AIDS?

A

-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

113
Q

MNT for oral or esophageal inflammation or lesions:

A

-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

114
Q

MNT for dysgeusia:

A

-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

115
Q

MNT for diarrhea:

A

-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

116
Q

If someone has HIV-associated Lipodystrophy Syndrome (HALS), they should follow the American College of Cardiology/American Heart Association Guidelines to…

A

-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

117
Q

We may consider ___ ___ when a patient cannot consume adequate nutrition orally

A

Enteral Nutrition

118
Q

Tube placement considerations:

A

-Duration of therapy
-GI function
-Avoid nasogastric tubes if painful esophageal lesions

119
Q

For enteral nutrition, use ___ ___, polymeric formulas

A

High protein

120
Q

If someone has fat malabsorption, use ___-___ formulas

A

Semi-elemental

121
Q

What is an indication of parenteral nutrition?

A

Severe GI dysfunction

122
Q

With parenteral nutrition, there is increased ____ risk, so we must consider risk vs benefits

A

Infection

Advanced Medical Nutrition Therapy (14 decks)

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