HIV Infection / AIDS

Best time to refer to the dietician:

• Diagnosis of HIV  infection/AIDS combined with at least one of the following:

• unwanted weight loss of more than 5% in a 1-month period or > 10% within a 6-month period
• if it is expected that food intake for at least 10 days will be < 500 kcal
• metabolic complications due to Highly Active Anti Retroviral Therapy (HAART)
• lipodystrophy, excessive weight (overweight or obese) and/or insulin resistance, hyperlipidemia
• renal impairment
• liver impairment
• osteoporosis
• decline in the growth curve for weight by > 1 SD and height by > 0.25 SD per year, in young children by > 1 SD in 3 months.

Relevant information for the dietician:

• Diagnosis of stage of HIV infection and related medical history, possible cause of decreased food intake and/or absorption, any comorbid conditions
• Symptoms: anorexia, nausea, vomiting, chewing difficulties, problems with food passage, painful mouth/esophagus, diarrhea, constipation, failure to thrive / weight loss
• Laboratory tests: CD4, viral load, total cholesterol, HDL cholesterol, triglycerides, glucose, HbA1c (depending on symptoms, measurement concerns renal function and liver function)
• Medications: antibiotics, antidiarrheal agents, antiemetics, appetite-stimulating drugs, antiretroviral drugs (HAART), chemotherapy
• Other: height, (changes in) weight

Aims of the diet:

• reduce symptoms
• maintain/achieve good growth curve / nutritional status
• extend life expectancy
• improve quality of life

Characteristics of the diet:

• Energy-enriched: asymptomatic HIV infection: basal metabolism (Harris & Benedict) + extra allowances
• Protein-enriched:

Children

• 1.5 - 3 g/kg of actual body weight, depending on age

Adults

• 1.5 - 2 g/kg of actual body weight

• Consistency: modify if necessary, based on the symptoms
• If there is diarrhea: If necessary, a lactose and sucrose restriction. In children, also possibly fructose restriction.
• Ensure a sufficient intake of fat, dietary fiber and fluids, based on national Nutritional Guidelines
• Recommend taking a multivitamin 1-2 x daily which has 100-150% RDA
• Pay attention to the impact of nutrition while antiretroviral drugs are being taken
• Pay attention to general hygiene
• For overweight: (see “Overweight”)
• For hyperlipidemia: see “Hypercholesterolemia”
• For Diabetes Mellitus: see “Diabetes Mellitus”
• For osteoporosis: see Metabolic Diseases > “Osteoporosis”

Treatment time:

• Care level 3*, see “Dietician’s working methods.”

References:

Drain PK, Kupka R et al. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. American Journal of clinical Nutrition. 2007 feb; (2):333-45

European AIDS Clinical Society. Guidelines on the Prevention and Management of Metabolic diseases in HIV. EACS: Paris, France; 2008

Jonkers-Schuitema CF, Eden J van. Voeding bij hiv en aids. Bohn Stafleu van Loghum, Houten: 2009

Ockenga J, Grimble R et al. ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases. Clinical Nutrition (2006)25:319-329

Valk M van der, Reiss P. Metabole bijwerkingen van antiretrovirale therapie. Ned Tijdschr Geneeskd. (2008) 31 mei; 152(22):1260-4

 HIV Infection/AIDS was updated by Patricia Bruynzeel and Nienke ter Horst, dieticians at Academisch Medisch Centrum (AMC).