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