NUTRITION AND HIV/AIDS

THE ROLE OF NUTRITION IN PREVENTION AND TREATMENT OF HIV/AIDS AND TUBERCULOSIS

       Objectives

—By the end of presentation every student will be able:

—Define HIV/AIDS and Tuberculosis

—Describe current situation of HIV/AIDS in Tanzania.

—Outline causes of poor nutrition and weight loss for PLHIV.

—Describe importance of nutrition for people living with HIV and Tuberculosis

—Nutritions needed for prevention and treatment of Tuberculosis and HIV/AIDS

        HIV/AIDS

—HIV” stands for Human Immunodeficiency Virus. To understand what that means, let’s break it down:

—H – Human – This particular virus can only infect human beings.

—I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.

—V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

—AIDS is the final stage of HIV infection, and not everyone who has HIV advances to this stage. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs).

—You are considered to have progressed to AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.

— What Is AIDS?

—AIDS” stands for Acquired Immunodeficiency Syndrome. To understand what that means, let’s break it down:

—A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.

—I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease.

—D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should.

—S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Current status of HIV and AIDS according to tacaids

—Overall, 5.1% of Tanzanians age 15-49 are HIV-positive. HIV prevalence is higher among women (6.2%) than among men (3.8%). HIV prevalence is higher in urban areas for both women and men than in rural areas.

A comparison of the 2007-08 THMIS and 2011-12 THMIS HIV prevalence estimates indicate that HIV prevalence has declined slightly from 5.7% to 5.1% among adults age 15-49. Similarly, HIV prevalence has declined among women, from 6.6% to 6.2%, and among men, from 4.6% to 3.8%.

Current status of HIV and AIDS Cont..

In Mainland Tanzania, HIV prevalence among women and men age 15-49 has decreased from 7.0% in the 2003-04 THIS to 5.3% in the 2011-12 THMIS. The decline in total HIV prevalence between 2003-04 and 2011-12 is statistically significant. Additionally, the decline is significant among men (6.3% versus 3.9%).

TUBERCULOSIS

—Tuberculosis is a chronic infectious disease caused by  bacterium known as mycobacterium tuberculosis that spread from person to person through air borne particles.

—Tuberculosis primarily affects the lungs, central nervous system lymphatic system and circulatory system.

—Tuberculosis is  transmitted from person with active pulmonary TB through coughing, sneezing and can be transmitted to others through inhalation of those droplets which are contaminated with mycobacterium tuberculosis.

Signs and symptoms

—Unexplained weight loss, persistence fatigue shortness   breathing, periodic fever, night sweating, chills, loss of appetite, coughing that last for three or more weeks, sputum productive sometimes with blood (haemoptysis),chest pain and pain with breathing or coughing.

—Also may present with headache, mingismus, decrease  mental status and negative blood culture  especially in extra pulmonary TB.

— THE IMPORTANCE OF NUTRITION FOR PEOPLE LIVING WITH HIV/AIDS

— •The effects of hiv(human immunodeficiency virus) on the nutrition of a person  infected with  virus are numerous.

• These effects follow a number of pathways, depending  on the stage of the hiv infection.

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•Health and nutrition  depends on the stage and severity of the infection.

—It is known that  good nutrition can contribute to the wellness  and sense of well-being of the person with HIV/AIDS at all stages of the disease and may even prolong life .

—Nutrition advice and support of people living with HIV /AIDS is therefore an important part of their care.

 NUTRITION THROUGH STAGES OF HIV INFECTIONS

—Good nutrition means different things at the various stages of HIV infections .

— Nutritional needs will vary according to the development of the disease.

—What is needed in each stage?

STAGE 1: HIV infected and still healthy

—Even though one may already be infected with HIV , there may be no symptoms of the disease, except perhaps a feeling of tiredness.

The goal during this stage is to keep the body weight stable in order to strengthen the body’s ability to fight infections with the immune system and to prevent progression of HIV illness.

—During the early stage of the infections the emphasize is on normal and healthy balanced eating patterns.

—Remember that no single food contains all the nutrients and goodness that the body needs.

—By concentrating on eating a variety of healthy foods, health can be maintained during this stage.

—Many people with the virus can live for ten years or more if they will maintain good nutrition.

STAGE 2: some problems but generally well

—When the HIV infection begin to cause health problems, it is necessary that the person with HIV/aids learn how to copy.

—The health problems may include sore mouth and throat and diarrhea caused by infections that take the advantage of the weakened immune system.

—These infections put extra demand on the immune system and increases the body’s need for energy and nutrients.

—Also poor eating habits will reduce the body’s ability to fight infections and will result in more infections.

—Illness may cause loss of appetite and medication may cause nausea, both of which may lead to poor food intake and weight loss.

—Eating may sometimes be uncomfortable or painful with mouth infections.

—With sometime PLWHIV starts to learn to cope and avoid some foods that causes problems or to adjust the amount they eat in order to feel better.

—But it is necessary to maintain one’s weight in order to delay the worsening of the diseases.

—Stage 3:more serious problems

lAs the disease develops more serious health problems will appear.

lAt the stage of HIV infection is completely weakened and very serious infection can occur.

lThis stage is called “full-down”AIDS and the body gradual become weaker, make a person less able to cope alone.

lPhysical help may help may be needed with daily tasks include shopping and in severe cases also food preparation and perhaps even eating.

lWeight loss or wasting become serious  problem and diarrhea occurs more often last longer.

lWith good nutrition the development of this stage slower and the patient can survive longer.

•                      —If a person with HIV/AIDS has a good appetite and is eating well, but is still feeling ill and

losing weight rapidly during this stage ,it might be a sign that there is an infection such as

tuberculosis.

  —Advice should be sought from the health workers if this is a case.

RALATIONSHIP BTN HIV/AIDS AND NUTRITION

lThe relationship between HIV/AIDS and poor nutrition is cyclical.

lThis means that in the development of the disease one problem worsens the other.

lUnless the cycle is broken poor nutrition will result.

lPoor nutrition due to poor food intake, increased nutrient usage in the body and loss of nutrient from the body weakens the immune system which in turn decreases the ability of the body to fight other infections.

lThe weakened immune system result in repeated infections which in their turn due to poor nutrition and so the cycle continues.

HIV/AIDS increases nutritional needs:

lThe virus itself  has an effect on the nutrition of the person living with HIV/AIDS.

lThe body reacts to the virus if an immune response that uses more energy and nutrients,

lOther infections start to occur and every new infections raises the need for nutrient and energy.

HIV/AIDS LOWERS FOOD INTAKE:

lInfections and illness lead to poor appetite.

lMouth and throat infections cause difficulties with eating.

lSome medicine cause poor sense of taste as a side effect.

lBoth the expense of treatment and inability to work affect income that leaves less money available for food.

lDepression, fear and anxiety contribute to the loss of appetite.

lIsolation may result from social prejudice against people with HIV/AIDS.

lBecause food and eating is a social events, loneliness will affect the way a

person eats.

In the late stage of disease people with HIV/AIDS may find it difficult to take

care of themselves. 

PHYSICAL PROBLEMS CAUSED BY HIV/AIDS

•The lining of the gut deteriorates due to HIV and other infections, affecting the ability of the gut to digest and absorb food.

•This inability of the gut to take up nutrients from the foods that are eaten is called mal-absorption.

•The results of mal-absorption is diarrhea. During diarrhea water and nutrients are lost from the body.

HIV/AIDS LOWERS FOOD INTAKE:

lInfections and illness lead to poor appetite.

lMouth and throat infections cause difficulties with eating.

lSome medicine cause poor sense of taste as a side effect.

lBoth the expense of treatment and inability to work affect income that leaves less money available for food.

lDepression, fear and anxiety contribute to the loss of appetite.

CAUSES OF POOR NUTRITION AND WEIGHT LOSS FOR PLHIV.

—The virus causes increased needs for energy and protein.

—Repeated infections and fever.

—Loss of appetite.

—Reduced food intake due to eating problems.

—Poor absorptions of nutrients from foods.

—Nutrient losses in urine and stool.

—Depression and anxiety.

—Medications and reduced ability to care for oneself.

—Access to and availability of foods

BREAKING A CYLCE OF HIV/AIDS AND POOR NUTRITION.

ØThe effective ways includes;

—Awareness of the HIV status.

—Good nutrition, getting enough rest and sleep.

—Learning how to cope with HIV/AIDS.

—Early detection and treatment of all infections.

—Increased food intake after illness.

—Increased activities and exercises.

Good hygiene and cleanliness.

—Management of household resources(food, money and

family time)

RDA FOR PEOPLE LIVING WITH  HIV/AIDs

—Energy requirements are likely to increase by 10% to maintain body weight and physical activity in  asymptomatic HIV-infected adults, and growth in asymptomatic children.

—During symptomatic HIV, and subsequently during AIDS, energy requirements increase by approximately 20% to 30% to maintain adult body weight

—Energy intakes need to be increased by 50% to 100% over normal requirements in children experiencing weight loss

ADULTS

—Studies point to low energy intake combined with increased energy demands due to HIV infection and related infections as the major driving forces behind HIV-related weight loss and wasting.

— Based on increased resting energy expenditure (REE)  observed in studies of HIV-infected

—expenditure have not shown an increase in total energy expenditure(TEE), this may have been the result of individuals compensating by reducing activity-related energy expenditure (AEE).

—Since maintaining physical activity is highly desirable for preserving quality of life and maintaining muscle tissue, it is undesirable that energy intake should only match a reduced level of AEE.

—The adults, it is recommended that energy be increased by 10% over accepted levels for otherwise healthy people.

— The goal is to maintain body weight in asymptomatic HIV-infected adults.

— Although studies of energy expenditure have not shown an increase in total energy expenditure (TEE), this may have been the result of individuals compensating by reducing activity-related energy expenditure (AEE)

CHILDREN

— There are few studies on energy expenditure in HIV-infected children

—Energy requirements in children can vary according to the type and duration of HIV-related infections, and whether there is weight loss along with acute infection.

—Although the finding of increased resting energy expenditure in asymptomatic disease has not been replicated in children.

—Similar to  asymptomatic HIV-infected adults an average increase of 10% of energy intake is recommended to maintain growth.

Based on clinical experience and existing guidelines to achieve catch-up growth in children irrespective of HIV status, energy intakes for HIV-infected children experiencing weight loss need to be increased by 50% to 100%—

—PREGNANT AND LACTATING WOMEN

—At present, there are no specific data on the impact of HIV/AIDS and related conditions on energy needs during pregnancy and lactation over and above those requirements already identified for non-infected women.

—For now, the recommended energy intake for HIV-infected adults should also apply to pregnant and lactating HIV-infected women.

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——They need to increase their energy requirements:

—Asymptomatic -need to increase energy intake by 10% to maintain body weight.

—Symptomatic -increase energy intake by 20% to 30%

—Increase quantity of foods

—Sincrease frequency of meals 

CARBOHYDRATES

—Carbohydrates: provide a rich source of energy for all body functions. When a person does not eat sufficient carbohydrates the body will use its stored protein for energy.

—It is therefore important for PLHIV to meet their daily carbohydrate requirements so as to avoid the use of stored protein which is highly needed.

—THEREFORE; make starch foods the basic of each meal.

PROTEIN

—Data are insufficient to support an increase in protein requirements due to HIV infection.

—There are insufficient data at present to support an increase in protein intake for PLWHA above normal requirements for health i.e. 15% to 20% of total energy intake

FAT

—There is no evidence that total fat needs are increased beyond normal requirements as a consequence of HIV infection.

—However, special advice regarding fat intake might be required for individuals undergoing anti-retroviral therapy or experiencing persistent diarrhoea 

MICRONUTRIENTS

—To ensure micronutrient intakes at RDA levels, HIV-infected adults and children are encouraged to consume healthy diets.

—Nevertheless, dietary intake of micronutrients at RDA levels may not be sufficient to correct nutritional deficiencies in HIV-infected individuals.

—There is evidence that some micronutrient supplements, e.g. vitamin A, zinc and iron, can produce adverse outcomes in HIV-infected populations.

—The role of micronutrients in immune function and infectious disease is well established.

—However, the specific role of individual and multiple micronutrients in the prevention, care and treatment of HIV infection and related conditions merits further attention. Several studies on micro-nutrients and HIV are under way, and new findings should be available —

 that there is evidence that supplements of, for example, B-complex vitamins, and vitamins C and E, can improve immune status, prevent childhood diarrhoea and enhance pregnancy outcomes, including better maternal prenatal weight gain and a reduction of fetal death, preterm birth and low birth weight. 

—The effect of these micronutrients on HIV disease progression and mortality is under study.

—Micronutrients that have produced positive health outcomes in HIV-uninfected populations include zinc supplementation for reducing diarrhea and pneumonia morbidity in children. The safety and effective-ness of zinc supplements in HIV-infected adults and children are now being studied.

WATER

—Water: although water is not food, it may be regarded as the most important nutrient as it

—is the body’s principal transporting agent and an indispensable agent in metabolic

—activities of all cells.

THE BENEFITS OF GOOD NUTRITION

—Keep weight stable and prevent loss of muscle

—Replace lost nutrients.

—Improve wound healing and recover from infections.

—Increase strength and feeling of well being.

—Deal better with medications and treatment.

—Helps to deal with some of the problems resulting from HIV/AIDS.

  

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