Question

Explain the effects of malnutrition in AIDS clients. List at least two interventions to improve this condition.

Answer 1

Ans) Effect of malnutrition in AIDS clients:

-Malnutrition has been documented in all stages of HIV infection
-With the evolution of HAART, nutritional problems have shifted to include more chronic disease issues such as hyperlipidemia, insulin resistance, and DM
-It is important to realize that much of the world does not have access to these medication regimens, and that some people choose not to use them; In these populations, malnutrition is still common.
-This classification defines wasting as an involuntary weight loss of greater than 10% in 1 month with the presence of chronic diarrhea, weakness, or fever for more than 30 days in the absence of a concurrent illness or condition
-The presence of malnutrition and weight loss is still considered an important predictor of both morbidity and mortality from the disease.
-Malnutrition in HIV and AIDS is multifactorial
-immunity-->infection-->intake, digestion, absorption alterations in bowel activity and metabolism-->malnutrition and weight loss.

Intervention to improve this condition:

Nutrition:

-The initial step in assessing nutritional risk is to evaluate anthropometric data. Body weight compared with the client's usual body weight is much more crucial that comparison with ideal body weight. Any unexplained weight loss should be noted, but weight loss of greater than 10% in 6 months is considered to place the client at risk. Calculation of BMI also identifies nutritional risk. A calculated BMI of less than 18 is associated with malnutrition and has been associated with an increased risk of mortality
-Shifts in lean body mass can be noted, although weight may be initially maintained.
-Bioelectrical Impedance has ben successfully used to evaluate changes in lean body mass. If BIA is not available, a calculation of upper-arm muscle area can be useful in providing a baseline measurement for which the client can be monitored over time
-Biochemical indices include those monitoring disease progression (CD4 or viral load); acute phase proteins that measure inflammatory processes, and overall visceral protein stores (serum albumin and pre albumin) can be used to monitor more acute changes. Other measures such as transferrin are not applicable bc of possible bone marrow suppression in this population
-Dietary assessment may be evaluated by 24 hr recall, food frequency, or food diary. Careful attention should be made to GI function, the presence of steatorrhea and diarrhea, and any other physical symptoms that may interfere with adequate oral intake.
-Using multiple parameters will allow a more thorough evaluation of the patients nutritional status and risk for PEM. The subjective Global Assessment tool also serves as an excellent screening tool for HIV/AIDS patients to determine nutritional risk and to assess the need of referral to an RD.

Exercise:

- Regular aerobic exercise and resistance training have been suggested to assist with lipid abnormalities, the fat redistribution syndrome, and other body composition changes noted in those patients with HIV/AIDS.
-Recommendations should be individualized and initiated slowly after receiving a physician's approval
Benefits:
-Increased muscle volume, strength, functional capacity, quality of life
-Decreased abdominal fat
-Prevention of glucose abnormalities and improved insulin sensitivity
-Improved circulation
-Improved bone metabolism

Multidisciplinary Approach:

-Malnutrition and wasting associated with HIV infection/AIDS are multifactorial
-Many aspects are not well understood, but that does not negate the fact that nutrition assessment, counseling, and support are critical components of the medical care for HIV/AIDS
-Early recognition and intervention for nutritional factors are keys to effective nutrition support and related medical therapies.