Nutrition and HIV

Vivian Pribram, Specialist Dietitian, King’s College Hospital, London, UK

• List of Contributors xivPreface xviiiAcknowledgements xixSECTION 1: INTRODUCTION1 Introduction to Human Immunodeficiency Virus 3Tanya Welz, Amanda Samarawickrama, Vivian Pribram, Bavithra Nathan, Lisa Hamzah and Emily Cheserem1.1 Introduction 31.2 Current state of the epidemic 41.3 HIV transmission 51.4 About the virus 61.5 Diagnosis of HIV 81.6 Measurement of CD4 cells 81.7 Natural history of untreated HIV infection and AIDS 101.8 Staging and classification of HIV disease 101.9 Monitoring the HIV pandemic 121.10 Prevention 131.11 Effect of antiretroviral therapy on the HIV epidemic 141.12 Stigma 142 Introduction to Nutrition and HIV 18Vivian Pribram2.1 Introduction 182.2 Malnutrition, infectious disease and immune function 192.3 HIV infection and decreased nutritional status 212.4 Nutritional screening and assessment 222.5 Metabolic and morphological complications 232.6 Paediatric undernutrition and maternal and child health 242.7 Healthy eating and management of HIV for well-being and longevity 262.8 Management of co-morbidities and serious non-HIV conditions 272.9 End-of-life care and ethical issues 29SECTION 2: PAEDIATRIC NUTRITION, MATERNAL AND CHILD HEALTH3 Malnutrition, Infant Feeding, Maternal and Child Health 35Theresa Banda, Vivian Pribram, Margaret Lawson, Catherine Mkangama and Gertrude Nyirenda3.1 Introduction 353.2 Maternal health and nutrition 363.3 Mother-to-child transmission 413.4 Infant feeding in the context of HIV 433.5 Malnutrition in children with HIV 494 Paediatric Nutritional Screening, Assessment and Support 58Lisa Cooke4.1 Introduction 584.2 Nutritional assessment and screening 584.3 Dietary assessment – what to do 614.4 Nutritional support 685 Adherence, Symptom Management, Psychological Aspects and Multidisciplinary Care of Children with HIV 72Daya Nayagam, Paul Archer, Susheela Sababady, Shema Doshi, and Ella Sherlock5.1 Transmission of HIV in children and young people 725.2 Prevention of mother-to-child transmission (vertical transmission) 735.3 Clinical presentation of paediatric HIV infection 735.4 Failure to thrive 735.5 Central nervous system 745.6 Hepatosplenomegaly 745.7 Older children 745.8 HIV disease and opportunistic infections 745.9 Prophylaxis 745.10 Antiretroviral treatment for children 755.11 Monitoring of paediatric HIV infection 775.12 Caring for children and their families in the community 775.13 Adherence, symptom management, psychological aspects and multidisciplinary care of children with HIV and AIDS 785.14 Nutritional care in a multidisciplinary team setting 815.15 The psychological effects of HIV on family functioning – key themes which arise in a child setting 826 Healthy Eating, Prevention and Management of Obesity and Long-Term Complications in Children 87Julie Lanigan6.1 Introduction 876.2 Metabolic complications 886.3 Malnutrition and HIV 886.4 Micronutrients and HIV 886.5 Obesity 906.6 Lipodystrophy 916.7 Assessment and monitoring 946.8 Dietary intake assessment 946.9 Advice for healthy eating 946.10 Conclusion 100SECTION 3: NUTRITIONAL MANAGEMENT OF HIV DISEASE7 Decreased Nutritional Status and Nutritional Interventions for People Living with HIV 107Vivian Pribram7.1 Introduction/Background 1077.2 Malnutrition, weight loss and wasting 1077.3 Significance of involuntary weight loss 1087.4 Definitions of HIV-related weight loss and wasting 1097.5 Prevalence 1107.6 Aetiology 1107.7 Nutritional requirements 1167.8 Nutritional management 1177.9 Non-nutritional treatments for HIV-related muscle wasting 1227.10 Micronutrients 1257.11 Conclusions 1288 Nutritional Screening and Assessment 132Sarah Woodman, Michelle Sutcliffe and Amy McDonald8.1 Overview 1328.2 Nutritional screening in the clinical setting 1348.3 Nutritional assessment 1368.4 Biochemical assessment 1468.5 Clinical assessment 1488.6 Dietary and lifestyle assessment 1508.7 Conclusion 1539 Symptom Control and Management 157Louise Houtzager and Tim Barnes9.1 Symptoms experienced by people living with HIV 1579.2 Referring patients to a dietitian for symptom control and management 1589.3 Goals of dietary symptom management strategies 1599.4 Symptom control and management of diarrhoea 1599.5 Symptom control and management of loss of appetite 1659.6 Mouth pain, taste changes and swallowing difficulties 1659.7 Reflux (heartburn) 1709.8 Symptom control and management of nausea and vomiting 1719.9 Symptom control and management of fatigue 1719.10 Conclusion 17410 The Nutritional Management of Complications Associated with HIV and Antiretroviral Therapy 176Alastair Duncan and Karen Klassen10.1 Introduction 17610.2 Aetiology of metabolic side effects 17710.3 Prevalence of metabolic side effects 17810.4 Assessment of metabolic parameters and cardiovascular disease risk 17910.5 Management of dyslipidaemias 18010.6 Management of impaired glucose metabolism 18510.7 Management of altered fat distribution 18810.8 Altered bone metabolism 19310.9 Management of lactic acidaemia 19910.10 Peripheral neuropathy 19910.11 Routine assessment, dietary and lifestyle management of metabolic complications 20010.12 Summary 20111 Community Interventions in Resource-Limited Settings 212Claire de Menezes and Kate Ogden11.1 Introduction 21211.2 HIV and nutrition in resource-limited settings 21311.3 Assessment of needs and capacities 21511.4 Targeting 21711.5 Nutrition counselling and education 21811.6 Targeted food supplementation programmes 22111.7 Support of HIV-positive pregnant women 22311.8 Breastfeeding and infant feeding support 22511.9 Support for other vulnerable groups 22711.10 Treatment of severe acute malnutrition in HIV context 22911.11 Micronutrient supplementation programmes 23011.12 Livelihood support and ensuring access to food 23011.13 Community mobilisation to support people living with HIV 23411.14 Monitoring 23611.15 Other issues 23711.16 Conclusion 238SECTION 4: HEALTHY LIVING AND LONG-TERM MANAGEMENT12 Medications, Adherence and Interactions with Food 243Angela Bailey12.1 HIV medications – background 24312.2 Drug interactions 25612.3 Micronutrients used in HIV infection 25712.4 Food and drug interactions 25712.5 Adherence 26112.6 Adherence and food 26412.7 Looking to the future 26612.8 Conclusion 26813 Healthy Eating and Well-Being 275Vivian Pribram and Kirsten Foster13.1 Diet, lifestyle and disease prevention 27513.2 The importance of healthy eating for people living with HIV (PLHIV) 27613.3 Factors that affect healthy eating and improved well-being among PLHIV 27713.4 Other lifestyle factors that influence health outcomes 28013.5 Principles of healthy eating 28213.6 Portion sizes and quantity of food required 29513.7 Weight management for people living with HIV 29513.8 Summary 29914 Exercise and Physical Activity and Long-Term Management of HIV 302Joanna Lucy Bowtell and Rebecca Weissbort14.1 Introduction 30214.2 Observational studies 30414.3 Effect of exercise on immunological parameters 30514.4 Effect of exercise on wasting 30614.5 Management of metabolic disturbances with exercise programmes 30814.6 Effect of exercise on quality of life and physical capacity 31214.7 Exercise prescription for people living with HIV/AIDS 31314.8 Practical considerations for exercise prescription 31414.9 Exercise programme for a patient living with HIV 31614.10 Conclusion 31915 Mental Health 324Shirley Hamilton and Christian Lee15.1 Introduction 32415.2 Mental disorders and nutrition 32415.3 Acute cognitive impairment 32515.4 Delirium and nutrition 32615.5 Chronic cognitive impairment 32615.6 Chronic cognitive impairment and nutrition 32715.7 Depression 32715.8 Depression and nutrition 32815.9 Management of depression 32915.10 Suicide 33215.11 Management of suicidal ideation 33315.12 Mania 33315.13 Mania and nutrition 33315.14 Anxiety 33415.15 Psychosis 33615.16 Socio-economic factors for mental health/HIV clients affecting nutrition 33915.17 Personality disorders 34015.18 Dual diagnosis 34015.19 Nutritional management of patients with HIV/mental health issues 34116 Complementary and Alternative Therapy 345Charle Maritz, Sharon Byrne and Vivian Pribram16.1 Introduction 34516.2 Safety and regulation of CAT therapy 34616.3 Use of CAT 34616.4 Factors influencing use of CAT 34716.5 CAT use in HIV 34716.6 Reasons for CAT use among PLHIV 34816.7 Information sources about CAT 34916.8 Disclosure of CAT use 34916.9 Evidence for the use of CAT 34916.10 Dietary supplements 35016.11 Dietary supplement use among PLHIV 35016.12 Knowledge of drug–CAT interactions 35116.13 Herbal remedies 35316.14 Addressing patients’ use of CAT 35616.15 Conclusions 35617 Food and Water Safety 360Louise Houtzager17.1 Introduction 36017.2 Why food and water safety is important for PLHIV 36017.3 Causes of food- and waterborne illness in PLHIV 36217.4 Management and prevention of food-borne illness 37317.5 Conclusion 380SECTION 5: THE NUTRITIONAL MANAGEMENT OF HIV AND CO-MORBIDITIES18 The Nutritional Management of Patients Living with Tuberculosis and HIV Co-Infection 385Louise Houtzager, Tim Barnes and Kirilee Matters18.1 Tuberculosis 38518.2 Epidemiology 38618.3 The relationship between tuberculosis and HIV 38718.4 Medical issues 38818.5 Nutrition, HIV infection and TB 39018.6 Nutrition screening 39218.7 Nutrition assessment: special considerations in TB 39218.8 Nutritional treatment/intervention 39318.9 Recommendations 39419 The Nutritional Management of Patients Living with HIV and Renal Disease 396Deepa Kariyawasam19.1 Introduction 39619.2 Presentation and symptoms 39719.3 Screening 39719.4 Diagnosis 39719.5 Classification of chronic kidney disease 39719.6 Treatment 39819.7 Methods of renal replacement therapy 39819.8 Renal transplantation 39919.9 Nutritional issues on dialysis 40219.10 Nutritional assessment 40219.11 Nutritional requirements 40319.12 Treatment 40319.13 Conclusion 40920 The Nutritional Management of Patients Living with HIV and Liver Disease 412Tracy Russell and Ruth Westwood20.1 Introduction 41220.2 Hepatitis B, hepatitis C and HIV 41320.3 Nutrition and liver disease 41520.4 Liver transplantation 42020.5 Nutritional interventions for hepatitis C 42020.6 HIV and non-alcoholic fatty liver disease 42120.7 Use of complementary and alternative therapies (CAT) in liver disease 42220.8 Vulnerable groups 42320.9 Conclusion 42421 Critical Care, Respiratory and Multi-organ Failure 427Sarah Cassimjee21.1 Background/overview 42721.2 Diseases and infections associated with ITU admission 42821.3 Sepsis and multiple organ dysfunction syndrome (MODS) 43021.4 Neurological failure 43021.5 Cardiovascular failure 43021.6 Gastrointestinal (GI) failure 43021.7 Liver failure 43021.8 Renal failure 43121.9 Medical treatment 43121.10 Nutritional considerations 43121.11 Nutritional assessment 43321.12 Nutritional requirements 43321.13 Nutritional treatments/intervention 43821.14 Early feeding and the use of enteral feeding protocols 43821.15 Conclusion 43922 Nutritional Management of Patients Living with HIV and Cancer 442Rachael Donnelly and Rachel Barrett22.1 Introduction 44222.2 Science of cancer 44322.3 Overview of cancer treatments 44422.4 Cancers in HIV infection 44722.5 Nutrition in the management of non-surgical oncology patients 451SECTION 6: PALLIATIVE, END OF LIFE CARE AND NUTRITION23 Nutrition and End of Life Care 459Vivian Pribram23.1 Introduction 45923.2 Palliative care 46123.3 Nutritional care in later stages of progressive illness 46223.4 Ethical and legal considerations 46423.5 Withdrawal of nutrition 46923.6 Implications for practice 47023.7 Conclusion 470APPENDICES 473Appendix 1 WHO Clinical Staging of HIV/AIDS for Adults and Adolescents 475Appendix 2 Weight-for-Height Reference Card (87 cm and above) 477Appendix 3 Weight-for-Length Reference Card (below 87 cm) 478Appendix 4 Guidance Table to Identify Target Weight 479Appendix 5 Basic Steps in Estimating Energy Requirements for Adults 480Appendix 6 NICE Guidelines: What to Give in Hospital and the Community 482Appendix 7 Basic Steps in Estimation of Nitrogen Requirements for Adults (Source: Elia, 1990) 484Appendix 8 Summary of ESPEN Statements: HIV and Nutritional Therapy 485Appendix 9 Form for Monitoring Anthropometry Measurements 487Appendix 10 Equations to Calculate Height and Estimation of Height from Ulna Length 488Appendix 11 Mid Upper Arm Circumference (MUAC) 490Appendix 12 Mid Arm Muscle Circumference (MAMC) 491Appendix 13 Biochemical Reference Ranges 492Appendix 14 Ways to Improve Adherence to TB Medication 493Appendix 15 The BCG Vaccination 494Index 495

“Students and other health care professionals working and studying this area will also find Nutrition and HIV an important and valuable resource.”  (MedReview, 1 November 2012)"This book delivers comprehensive, evidenced-based information on the nutritional management of HIV patients. Given the great detail, it would best serve as a resource for dietitians who regularly care for HIV patients." (Doody's, 19 August 2011)