Nutrition And HIV

Question 1

Aetiology of HIV infection

Answer 1

• HIV virus infects CD4 T cells, replicates, and destroys the cell
• typical trajectory of infection are to initially have very high virus levels (patient could have flu-like symptoms), virus falls but CD4 levels gradually declines over time

Question 2

AIDS definition and nutritional consequences

Answer 2

• when CD4 levels decrease below 200
• dont have this anymore due to ART
• nutritional consequences of AIDS: muscle wasting, weight loss, reduced mobility, difficulty swallowing and sore mouth (due to infection), altered taste perception, abdominal pain, diarrhoea, malabsorption

Question 3

How to manage malabsorption in HIV/AIDS

Answer 3

• electrolyte and fluid replacement
• treat underlying infection
• MCT feeds to improve stool frequency and consistency
• low fat with fat soluble vitamins
• reduced lactose intake
• vitamin B12 injections
• peptide and soluble fibre
• TPN

Question 4

Antiretroviral therapy

Answer 4

• BHIVA 2016 guidelines recommend to begin ART on all HIV patients straight away
• ART need to be taken vigilantly to stop virus from becoming immune
• u=u (undetectable viral load means it is untransmittable)

Question 5

Infant feeding for HIV positive mothers

Answer 5

• even if on ART it is not recommended that mother’s breastfeed, 1% chance of transmission at 6 months and 3% at 12 months
• if they do decide to breastfeed, mothers must discuss their thoughts, and plan accordingly. They can feed if fully suppressed viral load, but this needs to be monitored and must be prepared for stopping quickly
• women need support for formula feeling: need to provide starter pack for feeding, practical support of prep and storage of milk, for low income household can provide prescription for formula milk

Question 6

Side effects effects of ART

Answer 6

• mood alteration, dizziness, sleep disturbance
• hypersensitivity reactions
• increased bilirubin
• renal side effects
• skin problems
• integrase inhibitors can cause weight gain (6kg over 5 years)
• dolutegravir (integrase inhibitors) cannot be taken with multivitamins or antacids

Question 7

Nutrition support for asymptomatic patients

Answer 7

• food and water safety (if <200 CD4 then need to be given boiled and cooled water, avoid takeaways, toxoplasmosis (cats))
• optimise nutritional status: balanced diet, treat deficiencies, gut health and microbiome
• maintain lean body mass
• address lifestyle factors impacting immune function: smoking, PA, stress, alcohol use
• preventing non-communicable diseases

Question 8

HIV metabolic comorbidities

Answer 8

• CVD
• dyslipidemia (caused by ART and HIV)
• diabetes
• obesity
• hypertension
• CKD
• osteopenia
• osteoporosis
• fragility fractures
• frailty

Question 9

CVD in HIV: BHIVA recommendations, EACS guidelines and efficacy of dietary interventions

Answer 9

• BHIVA: recommend traditional modifying risk factors (smoking cessation), switching ART (as long as no risk of treatment failure)
• EACS: reduce sat fat to improve LDL, change ART, statins, PCSK9 inhibitor
• dietary intervention: Mediterranean diet with portfolio foods (eg oats) can reduce LDL by 10% at 6 months

Question 10

Barriers to dietary change in HIV

Answer 10

• social expectations (ie monitoring cholesterol for younger patients)
• cultural: different ways of eating
• rationalising health problems
• cost
• time
• effort