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Clinical Conditions: AIDS

HIV/AIDS patients acquired importance in clinical nutrition practice due to malnutrition and side effects of antiretroviral therapy. Even in HAART (Highly Active Antiretroviral Therapy) era, the number of patients with weight loss and significant changes in body composition was not small. Thus, it is recommended to act immediately on any asymptomatic HIV+ individual, or with active AIDS, who experience weight loss (1).

Studies indicate that weight loss continues as an important complication, including in population with access to HAART. Studies showed that 18% of patients, monitored for one year, lost >10% of body weight during a series of visits, while 21% lost >5% and 8% presented Body Mass Index (BMI) [sic]

The objectives of Nutritional Therapy (NT) for these patients are (1):

-to prevent malnutrition, especially loss of body weight;

-to minimize symptoms and to prevent HIV infections and other opportunistic infections;

-to improve antiretroviral treatment tolerance;

-to help maintain body composition;

-to promote better quality of life.

For these patients, an indication of NT is similar to other medical conditions, especially in the presence of malnutrition. When the patient experiences a significant weight loss (> 5% in three months), or depletion of muscle mass (> 5% in three months) it must also be considered in patients with BMI

Oral supplements are indicated when the patient is fed orally, but not sufficiently to keep his/her energy requirements. For patients with no complications who want to gain weight, the use of oral supplements can greatly help increase food intake. Enteral route should be considered whenever oral feeding is insufficient (1,3).

References

1. Projeto Diretrizes - DITEN. Terapia Nutricional na Síndrome da Imunodeficiência Adquirida (HIV/AIDS). 2011. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_na_sindrome_da_imunodeficiencia_adquirida_hiv_aids.pdf) [Guidelines Project - DITEN. Nutritional therapy in acquired immunodeficiency syndrome (HIV/AIDS). 2011. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_na_sindrome_da_imunodeficiencia_adquirida_hiv_aids.pdf)]

2. Wanke C, Silva M, Knox T, Forrester J, Speigelman, Gorbach S. Weight and wasting remain common complications in individual infected with HIV in the era of highly active antirretroviral therapy. Clin Infec Dis 2000;31:803-5.

3. Koethe JR, Heimburger DC. Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr 2010;91:1138S-42S.

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