Nutrition and HIV

List of Contributors xiv

Preface xviii

Acknowledgements xix

SECTION 1: INTRODUCTION

1 Introduction to Human Immunodeficiency Virus 3
Tanya Welz, Amanda Samarawickrama, Vivian Pribram, Bavithra Nathan, Lisa Hamzah and Emily Cheserem

1.1 Introduction 3

1.2 Current state of the epidemic 4

1.3 HIV transmission 5

1.4 About the virus 6

1.5 Diagnosis of HIV 8

1.6 Measurement of CD4 cells 8

1.7 Natural history of untreated HIV infection and AIDS 10

1.8 Staging and classification of HIV disease 10

1.9 Monitoring the HIV pandemic 12

1.10 Prevention 13

1.11 Effect of antiretroviral therapy on the HIV epidemic 14

1.12 Stigma 14

2 Introduction to Nutrition and HIV 18
Vivian Pribram

2.1 Introduction 18

2.2 Malnutrition, infectious disease and immune function 19

2.3 HIV infection and decreased nutritional status 21

2.4 Nutritional screening and assessment 22

2.5 Metabolic and morphological complications 23

2.6 Paediatric undernutrition and maternal and child health 24

2.7 Healthy eating and management of HIV for well-being and longevity 26

2.8 Management of co-morbidities and serious non-HIV conditions 27

2.9 End-of-life care and ethical issues 29

SECTION 2: PAEDIATRIC NUTRITION, MATERNAL AND CHILD HEALTH

3 Malnutrition, Infant Feeding, Maternal and Child Health 35
Theresa Banda, Vivian Pribram, Margaret Lawson, Catherine Mkangama and Gertrude Nyirenda

3.1 Introduction 35

3.2 Maternal health and nutrition 36

3.3 Mother-to-child transmission 41

3.4 Infant feeding in the context of HIV 43

3.5 Malnutrition in children with HIV 49

4 Paediatric Nutritional Screening, Assessment and Support 58
Lisa Cooke

4.1 Introduction 58

4.2 Nutritional assessment and screening 58

4.3 Dietary assessment – what to do 61

4.4 Nutritional support 68

5 Adherence, Symptom Management, Psychological Aspects and Multidisciplinary Care of Children with HIV 72
Daya Nayagam, Paul Archer, Susheela Sababady, Shema Doshi, and Ella Sherlock

5.1 Transmission of HIV in children and young people 72

5.2 Prevention of mother-to-child transmission (vertical transmission) 73

5.3 Clinical presentation of paediatric HIV infection 73

5.4 Failure to thrive 73

5.5 Central nervous system 74

5.6 Hepatosplenomegaly 74

5.7 Older children 74

5.8 HIV disease and opportunistic infections 74

5.9 Prophylaxis 74

5.10 Antiretroviral treatment for children 75

5.11 Monitoring of paediatric HIV infection 77

5.12 Caring for children and their families in the community 77

5.13 Adherence, symptom management, psychological aspects and multidisciplinary care of children with HIV and AIDS 78

5.14 Nutritional care in a multidisciplinary team setting 81

5.15 The psychological effects of HIV on family functioning – key themes which arise in a child setting 82

6 Healthy Eating, Prevention and Management of Obesity and Long-Term Complications in Children 87
Julie Lanigan

6.1 Introduction 87

6.2 Metabolic complications 88

6.3 Malnutrition and HIV 88

6.4 Micronutrients and HIV 88

6.5 Obesity 90

6.6 Lipodystrophy 91

6.7 Assessment and monitoring 94

6.8 Dietary intake assessment 94

6.9 Advice for healthy eating 94

6.10 Conclusion 100

SECTION 3: NUTRITIONAL MANAGEMENT OF HIV DISEASE

7 Decreased Nutritional Status and Nutritional Interventions for People Living with HIV 107
Vivian Pribram

7.1 Introduction/Background 107

7.2 Malnutrition, weight loss and wasting 107

7.3 Significance of involuntary weight loss 108

7.4 Definitions of HIV-related weight loss and wasting 109

7.5 Prevalence 110

7.6 Aetiology 110

7.7 Nutritional requirements 116

7.8 Nutritional management 117

7.9 Non-nutritional treatments for HIV-related muscle wasting 122

7.10 Micronutrients 125

7.11 Conclusions 128

8 Nutritional Screening and Assessment 132
Sarah Woodman, Michelle Sutcliffe and Amy McDonald

8.1 Overview 132

8.2 Nutritional screening in the clinical setting 134

8.3 Nutritional assessment 136

8.4 Biochemical assessment 146

8.5 Clinical assessment 148

8.6 Dietary and lifestyle assessment 150

8.7 Conclusion 153

9 Symptom Control and Management 157
Louise Houtzager and Tim Barnes

9.1 Symptoms experienced by people living with HIV 157

9.2 Referring patients to a dietitian for symptom control and management 158

9.3 Goals of dietary symptom management strategies 159

9.4 Symptom control and management of diarrhoea 159

9.5 Symptom control and management of loss of appetite 165

9.6 Mouth pain, taste changes and swallowing difficulties 165

9.7 Reflux (heartburn) 170

9.8 Symptom control and management of nausea and vomiting 171

9.9 Symptom control and management of fatigue 171

9.10 Conclusion 174

10 The Nutritional Management of Complications Associated with HIV and Antiretroviral Therapy 176
Alastair Duncan and Karen Klassen

10.1 Introduction 176

10.2 Aetiology of metabolic side effects 177

10.3 Prevalence of metabolic side effects 178

10.4 Assessment of metabolic parameters and cardiovascular disease risk 179

10.5 Management of dyslipidaemias 180

10.6 Management of impaired glucose metabolism 185

10.7 Management of altered fat distribution 188

10.8 Altered bone metabolism 193

10.9 Management of lactic acidaemia 199

10.10 Peripheral neuropathy 199

10.11 Routine assessment, dietary and lifestyle management of metabolic complications 200

10.12 Summary 201

11 Community Interventions in Resource-Limited Settings 212
Claire de Menezes and Kate Ogden

11.1 Introduction 212

11.2 HIV and nutrition in resource-limited settings 213

11.3 Assessment of needs and capacities 215

11.4 Targeting 217

11.5 Nutrition counselling and education 218

11.6 Targeted food supplementation programmes 221

11.7 Support of HIV-positive pregnant women 223

11.8 Breastfeeding and infant feeding support 225

11.9 Support for other vulnerable groups 227

11.10 Treatment of severe acute malnutrition in HIV context 229

11.11 Micronutrient supplementation programmes 230

11.12 Livelihood support and ensuring access to food 230

11.13 Community mobilisation to support people living with HIV 234

11.14 Monitoring 236

11.15 Other issues 237

11.16 Conclusion 238

SECTION 4: HEALTHY LIVING AND LONG-TERM MANAGEMENT

12 Medications, Adherence and Interactions with Food 243
Angela Bailey

12.1 HIV medications – background 243

12.2 Drug interactions 256

12.3 Micronutrients used in HIV infection 257

12.4 Food and drug interactions 257

12.5 Adherence 261

12.6 Adherence and food 264

12.7 Looking to the future 266

12.8 Conclusion 268

13 Healthy Eating and Well-Being 275
Vivian Pribram and Kirsten Foster

13.1 Diet, lifestyle and disease prevention 275

13.2 The importance of healthy eating for people living with HIV (PLHIV) 276

13.3 Factors that affect healthy eating and improved well-being among PLHIV 277

13.4 Other lifestyle factors that influence health outcomes 280

13.5 Principles of healthy eating 282

13.6 Portion sizes and quantity of food required 295

13.7 Weight management for people living with HIV 295

13.8 Summary 299

14 Exercise and Physical Activity and Long-Term Management of HIV 302
Joanna Lucy Bowtell and Rebecca Weissbort

14.1 Introduction 302

14.2 Observational studies 304

14.3 Effect of exercise on immunological parameters 305

14.4 Effect of exercise on wasting 306

14.5 Management of metabolic disturbances with exercise programmes 308

14.6 Effect of exercise on quality of life and physical capacity 312

14.7 Exercise prescription for people living with HIV/AIDS 313

14.8 Practical considerations for exercise prescription 314

14.9 Exercise programme for a patient living with HIV 316

14.10 Conclusion 319

15 Mental Health 324
Shirley Hamilton and Christian Lee

15.1 Introduction 324

15.2 Mental disorders and nutrition 324

15.3 Acute cognitive impairment 325

15.4 Delirium and nutrition 326

15.5 Chronic cognitive impairment 326

15.6 Chronic cognitive impairment and nutrition 327

15.7 Depression 327

15.8 Depression and nutrition 328

15.9 Management of depression 329

15.10 Suicide 332

15.11 Management of suicidal ideation 333

15.12 Mania 333

15.13 Mania and nutrition 333

15.14 Anxiety 334

15.15 Psychosis 336

15.16 Socio-economic factors for mental health/HIV clients affecting nutrition 339

15.17 Personality disorders 340

15.18 Dual diagnosis 340

15.19 Nutritional management of patients with HIV/mental health issues 341

16 Complementary and Alternative Therapy 345
Charle Maritz, Sharon Byrne and Vivian Pribram

16.1 Introduction 345

16.2 Safety and regulation of CAT therapy 346

16.3 Use of CAT 346

16.4 Factors influencing use of CAT 347

16.5 CAT use in HIV 347

16.6 Reasons for CAT use among PLHIV 348

16.7 Information sources about CAT 349

16.8 Disclosure of CAT use 349

16.9 Evidence for the use of CAT 349

16.10 Dietary supplements 350

16.11 Dietary supplement use among PLHIV 350

16.12 Knowledge of drug–CAT interactions 351

16.13 Herbal remedies 353

16.14 Addressing patients’ use of CAT 356

16.15 Conclusions 356

17 Food and Water Safety 360
Louise Houtzager

17.1 Introduction 360

17.2 Why food and water safety is important for PLHIV 360

17.3 Causes of food- and waterborne illness in PLHIV 362

17.4 Management and prevention of food-borne illness 373

17.5 Conclusion 380

SECTION 5: THE NUTRITIONAL MANAGEMENT OF HIV AND CO-MORBIDITIES

18 The Nutritional Management of Patients Living with Tuberculosis and HIV Co-Infection 385
Louise Houtzager, Tim Barnes and Kirilee Matters

18.1 Tuberculosis 385

18.2 Epidemiology 386

18.3 The relationship between tuberculosis and HIV 387

18.4 Medical issues 388

18.5 Nutrition, HIV infection and TB 390

18.6 Nutrition screening 392

18.7 Nutrition assessment: special considerations in TB 392

18.8 Nutritional treatment/intervention 393

18.9 Recommendations 394

19 The Nutritional Management of Patients Living with HIV and Renal Disease 396
Deepa Kariyawasam

19.1 Introduction 396

19.2 Presentation and symptoms 397

19.3 Screening 397

19.4 Diagnosis 397

19.5 Classification of chronic kidney disease 397

19.6 Treatment 398

19.7 Methods of renal replacement therapy 398

19.8 Renal transplantation 399

19.9 Nutritional issues on dialysis 402

19.10 Nutritional assessment 402

19.11 Nutritional requirements 403

19.12 Treatment 403

19.13 Conclusion 409

20 The Nutritional Management of Patients Living with HIV and Liver Disease 412
Tracy Russell and Ruth Westwood

20.1 Introduction 412

20.2 Hepatitis B, hepatitis C and HIV 413

20.3 Nutrition and liver disease 415

20.4 Liver transplantation 420

20.5 Nutritional interventions for hepatitis C 420

20.6 HIV and non-alcoholic fatty liver disease 421

20.7 Use of complementary and alternative therapies (CAT) in liver disease 422

20.8 Vulnerable groups 423

20.9 Conclusion 424

21 Critical Care, Respiratory and Multi-organ Failure 427
Sarah Cassimjee

21.1 Background/overview 427

21.2 Diseases and infections associated with ITU admission 428

21.3 Sepsis and multiple organ dysfunction syndrome (MODS) 430

21.4 Neurological failure 430

21.5 Cardiovascular failure 430

21.6 Gastrointestinal (GI) failure 430

21.7 Liver failure 430

21.8 Renal failure 431

21.9 Medical treatment 431

21.10 Nutritional considerations 431

21.11 Nutritional assessment 433

21.12 Nutritional requirements 433

21.13 Nutritional treatments/intervention 438

21.14 Early feeding and the use of enteral feeding protocols 438

21.15 Conclusion 439

22 Nutritional Management of Patients Living with HIV and Cancer 442
Rachael Donnelly and Rachel Barrett

22.1 Introduction 442

22.2 Science of cancer 443

22.3 Overview of cancer treatments 444

22.4 Cancers in HIV infection 447

22.5 Nutrition in the management of non-surgical oncology patients 451

SECTION 6: PALLIATIVE, END OF LIFE CARE AND NUTRITION

23 Nutrition and End of Life Care 459
Vivian Pribram

23.1 Introduction 459

23.2 Palliative care 461

23.3 Nutritional care in later stages of progressive illness 462

23.4 Ethical and legal considerations 464

23.5 Withdrawal of nutrition 469

23.6 Implications for practice 470

23.7 Conclusion 470

APPENDICES 473

Appendix 1 WHO Clinical Staging of HIV/AIDS for Adults and Adolescents 475

Appendix 2 Weight-for-Height Reference Card (87 cm and above) 477

Appendix 3 Weight-for-Length Reference Card (below 87 cm) 478

Appendix 4 Guidance Table to Identify Target Weight 479

Appendix 5 Basic Steps in Estimating Energy Requirements for Adults 480

Appendix 6 NICE Guidelines: What to Give in Hospital and the Community 482

Appendix 7 Basic Steps in Estimation of Nitrogen Requirements for Adults (Source: Elia, 1990) 484

Appendix 8 Summary of ESPEN Statements: HIV and Nutritional Therapy 485

Appendix 9 Form for Monitoring Anthropometry Measurements 487

Appendix 10 Equations to Calculate Height and Estimation of Height from Ulna Length 488

Appendix 11 Mid Upper Arm Circumference (MUAC) 490

Appendix 12 Mid Arm Muscle Circumference (MAMC) 491

Appendix 13 Biochemical Reference Ranges 492

Appendix 14 Ways to Improve Adherence to TB Medication 493

Appendix 15 The BCG Vaccination 494

Index 495