Nutrition Interventions and HIV

Practice Paper of the Academy of Nutrition and Dietetics: Nutrition Intervention and Human Immunodeficiency Virus Infection

Treatment of Human Immunodeficiency Virus (HIV) and Autoimmune Deficiency Syndrome (AIDS) can present many nutritional challenges, especially related to obesity due to treatments that have extended life expectancy for this population. Antiretroviral Therapies (ART)  have shifted nutrition concerns from undernutrition to obesity and cardiometabolic problems. HIV can alter metabolism, resulting in protein-energy malnutrition, anemias, and micronutrient deficiencies. Risks for chronic disease such as cardiovascular disease and diabetes are higher in this population than in the general population, and obesity and overweight incidence is increasing in people affected by this disease. Food insecurity is also higher than average in this population.

RDs should use the nutrition care process and nutrition focused physical exams to identify malnutrition and nutrition diagnoses. Practitioners should be aware of both over- and under- nutrition as forms of malnutrition. RDs should be aware of AIDS related wasting syndrome and the loss of subcutaneous fat, however ART has shown increases in body weight after initial weight loss is regained so RDs need to monitor shifts in body composition. Probiotic supplementation to treat diarrhea associated with wasting has not been fully tested, and there is no current recommendations on probiotic supplementation in this population. Metabolic abnormalities may result from the disease process, medications, treatments, or other infections, but ART may correct some abnormalities in metabolism. Iron stores should be assessed when anemia is present to identify whether it is resulting from chronic disease or nutrient deficiency. Monitoring cholesterol and blood pressure can help prevent CVD and CKD and should occur before and during ART implementation. Blood glucose should be screened periodically, before and after ART initiation.  Hormone levels can also impact CVD risk and other nutrient concerns, and RDs should be aware of transgender patients and how hormonal treatments may impact their nutrition care. Although side effects associated with ART are less common than in older versions of the drug, they may still pose nutrition related problems, such as diarrhea, anemia, and metabolic alterations.

It is recommended that patients see the RD 1-2 times per year if they are asymptomatic, and 2-6 times if they are symptomatic. Counseling and education in patients have proven to be beneficial. Resting energy expenditure tends to be higher in individuals with HIV, creating a need for higher energy intakes, however, with obesity becoming more prevalent, caloric intake should be closely monitored. Osteoporosis, CVD, diabetes, and hypertension are all comorbidities of the disease, and RDs can play a role in treating and preventing these conditions using MNT combined with other forms of medical and pharmaceutical treatment. HIV-positive patients are also more susceptible to foodborne illnesses, thus the RD can play a role in educating on food safety. The RD should also be familiar with complementary and alternative forms of treatment such as echinacea and St. John’s wort because these therapies are often used by patients with this and other chronic diseases.

New studies need to be done to identify acceptable time frames for monitoring and evaluating this population. For children with HIV, growth failure and loss of lean body mass are the most common problems. Children with HIV need very high energy and protein intake from nutrient dense foods, and may require additional supplementation. Women with HIV are not recommended to breastfeed due to the possible transmission of the disease.  For aging patients, the concern is often additional chronic diseases and interactions of drugs. Minorities are disproportionally affected by HIV and treatment outcomes are often not as good. RDs can be conscious of ethnic considerations and disparities in treatment and socioeconomic status.

AC

Academy of Nutrition and Dietetics (2018). Practice paper of the Academy of Nutrition and Dietetics: Nutrition intervention and human immunodeficiency virus infection. Journal of the Academy of Nutrition and Dietetics 118(3). Retrieved from: https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/practice-papers/hivpracticepaper .pdf?la=en&hash=E99F11F549A01371E98C5F4B9EFE52C729C7D396.