HIV/AIDS

Danielle Bourque
NTR 573
4/2/13

Overview
Brief History
Etiology/Pathophysiology
Prevalence
MNT
Terminology
Drug/Nutrient Interactions

History
Originated from infected chimpanzees in
Western Africa.
Simian immunodeficiency virus (SIV).

1981, the first case is reported.

In 1995, AIDS was the #1 leading cause of
death in the U.S. Today it is ranked #6.
In 1996, HAART became available.
About 25 million people have died of AIDS since
1981.

WHAT is HIV/AIDS?
Human immunodeficiency virus
(HIV) a retrovirus that targets
immune cells inside the body.
Two types:
HIV-1
HIV-2

Acquired immune deficiency

syndrome (AIDS)- advanced
stage of HIV usually diagnosed
when an opportunistic infection
has developed or if CD4+ cells
have dropped below a certain
level.

Transmission
Transmitted via bodily fluids containing blood.
Primary ways of transmission:
Sexually
Sharing infected needles
Being born to an infected mother. HIV can spread during
pregnancy, birth, or breast feeding.

Less common ways:

Being stuck with an HIV infected needle
Blood transfusions/organ transplants

HIV cannot be spread through tears, saliva, or sweat.

Relatively weak virus that cannot survive outside of the body.

Stages Of HIV/AIDS
Stages:

1.
2.
3.
4.

acute HIV infection

asymptomatic HIV infection
symptomatic HIV infection
AIDS or advanced HIV

Prevalence
About 1,148,200 million
people in the U.S. are
infected with HIV.
Every 9.5 minutes
someone in the U.S. is
infected with HIV.
About 33.4 million
people are currently
living with HIV/AIDS
globally.

Signs/Symptoms
Symptoms occur about 2-4
weeks after being infected.
Symptoms are not always
present. In some cases, it
can take up to 10 years for
symptoms to show.
Common symptoms:
Fever, chills, rash, night
sweats, diarrhea, muscle
aches, sore throat, swollen
lymph nodes, fatigue, ulcers
in mouth, nausea, dry
mouth, difficulty breathing,
constipation, and anorexia.

Diagnosis
HIV tests HIV rapid tests
ELISA test
Western blot
PCR test

First OTC: OraQuick

AIDS

CD4 lymphocyte count

below 200/mm3

opportunistic infections
present
AIDS related cancer

Conditions associated with

AIDS
Opportunistic infections Pneumonia, tuberculosis, herpes
Cancers Kaposis sarcoma, lymphomas, cervical cancer.

Neuromuscular diseases
HIV related encephalopathy, toxoplasmosis of the brain.

HIV-liver disease
HIV-associated Nephropathy
Gastrointestinal and pancreatic issues
HIV wasting syndrome

Nutrition Assessment
Anthropometrics
Height, weight, IBW, UBW, BMI, waist, hip, neck,
and thigh circumferences

Biochemical
Protein status, blood lipid profile, glucose/insulin
status, blood pressure, hemoglobin, hematocrit,
MCV, liver function tests, electrolytes, and bone
mineral density.

MNT
Goals:
1. Maintain and expand nutrition knowledge and sense of
empowerment.
2. Maintain or restore healthy body weight and normal
morphology.
3. Preserve or restore optimal somatic and visceral proteins.
4. Prevent nutrient deficiencies or excesses known to
compromise immune function.
5.Treat or minimize HIV or medication-related complications
that interfere with either intake or absorption of nutrients.
6. Correct metabolic abnormalities.
7. Support adherence to medications to achieve optimal
therapeutic drug levels.
8. Prolong and optimize quality of life.

MNT
Energy Needs
Depend on the health of the HIV infected person, but energy
requirements usually increase by about 13 percent.

Protein needs
1.6-1.8 g/kg body wt to reverse HIV wasting.
1-1.4g/kg for maintenance or 1.5 -2g/kg for repletion.

Fluid Needs
30-35ml/kg with additional amounts if diarrhea, nausea,
vomiting, or night sweats are present.

Vitamin/Mineral
It has been recommended that infected patients take a daily
multivitamin and mineral supplement to provide 100% of RDA.

MNT
Nausea Consume small frequent meals, avoid high-fat and greasy
foods

Sore mouth or throat Consume soft moist food, avoid spicy or acidic foods, and
consume nutrient dense foods.

Diarrhea Replace fluid and electrolytes, increase intake of soluble

fiber, avoid caffeine and take medications after meals.

Body cell mass loss Consume 500 calories above daily requirement and 1.6-1.8 g
P/kg body wt.

Terminology
Increased energy expenditure
Inadequate energy intake
Inadequate oral food/beverage intake
Altered GI function
Malnutrition
Inadequate protein-energy intake
Altered nutrition relates lab values
Food-medication interaction
Underweight
Involuntary weight loss

Drug and Drug-Nutrient

Interactions
Drug

Function

Side effects

DrugNutrient
Interactions

Protease Inhibitors
(PIs)

Inhibits the viral

replication cycle by
inhibiting protease
enzyme replication
that allow viral
proteins to be
reassembled into viral
cores

Appetite loss,
diarrhea, nausea,
vomiting, fatigue,
headache.,
hyperglycemia,
lipodystrophy
syndrome, elevated
cholesterol and
triglycerides,
abnormal liver
function labs.

AgeneraseAvoid excess vitamin

E, and grapefruit
juice.
Drink excess fluid.
Consuming more than
67 g fat will decrease
absorption.
St. Johns wort
Avoid garlic

Fusion Inhibitor:
Fuzeon

Inhibits the viral

replication cycle by
inhibiting fusion of
HIV virus to target cell

Pain at injection site,

nausea, diarrhea,
fatigue, pancreatitis

Decrease in appetite
and weight loss

Multi-Class
Combination:
Atripla

Combination of other
antiretroviral drugs in
one pill.

Lactic acidosis,
tingling in hands and
feet, decrease renal
function

Drugs and Drug-Nutrient

Interactions
Drug

Function

Side effects

DrugNutrient
Interaction

Nucleoside
Analogue Reverse
Transcriptase
Inhibitors (NRTIs)

Act as faulty versions

of building blocks HIV
need to replicate.
When HIV uses a NRTI,
replication is stalled.

Diarrhea, fever, rash,

anorexia, fatigue, liver
toxicity and
inflammation, anemia.

Avoid alcohol
Consume low fat
meals

Non-Nucleoside
Analogue Reverse
Transcriptase
Inhibitors (NNRTIs)

Bind to and inhibit

reverse transcriptase

Nausea, anorexia,
vomiting, diarrhea,
lactic acidosis, and
hyperlipidemia.

Avoid St. Johns wort

and alcohol.
Avoid high fat meals

Nucleotide
Analogue Reverse
Transcriptase
Inhibitors (NtRTIs)

Chemically activated
version of NRTIs

Abdominal pain,
anorexia, lactic
acidosis, and
hepatomegaly with
steatosis

VireadShould be taken with a

meal containing about
700-1000 and 40-50%
should be fat.

Drugs and Metabolic

Abnormalities
Antiretroviral treatment (ART) can cause
several metabolic abnormalities including:
Lipodystrophy
Low serum testosterone in both men and
women
Elevated serum triglycerides, insulin, glucose,
and blood pressure.
Increases risk of cardiovascular disease and
diabetes.

Bones loss, osteopenia, osteoporosis can

occur in patients taking protease inhibitors.

References
Mahan LK, Escott-Stump S. Krauses Food, Nutrition, and Diet Therapy, 12th Ed.Philadelphia: W.B. Saunders
Co., 2008.
S Escott-Stump. Nutrition and Diagnosis Related Care. 7th Ed. Lippincott Williams & Wilkins, 2011
M Nelms, K Sucher, S Long. Nutrition Therapy and Pathophysiology. Belmont, CA: Wadsworth/Thomson
Learning, 2007
Pronsky ZM. Food-Medication Interactions, 15th Ed., 2008.
CDC: HIV?AIDS. Available at: http://www.cdc.gov/hiv/default.htm. Accessed 3/29/2013.
FDA: HIV/AIDS available at:
http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm117891.htm.
Accessed 3/29/2013.
MedlinePlus: HIV/AIDS available at: http://www.nlm.nih.gov/medlineplus/hivaids.html. Accessed 3/28/2013.
HIV/AID basics available at: http://aids.gov/hiv-aids-basics/hiv-aids-101/statistics/. Accessed 3/31/2013.
Pictures:
http://virology-online.com/general/Test5.ht
http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hiv-and-aids.
htm
www.aids.gov
www.aidsinfo.org