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HIV/AIDS Case Study

Alex Corbett and Alana Sherman

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Background of HIV/AIDS
■ Major global health issue

■ Retrovirus targeting host immune cells→ attacks immune system

■ → turns host immune cells into “viral factories” for HIV production

■ Can potentially progress to acquired immunodeficiency syndrome (AIDS)

■ Increases vulnerability to opportunistic infections leading to disabilities/death
■ Body unable to fight off the most basic infections

■ Transmitted person to person via infected body fluids

■ Currently, no cure exists

■ Antiretroviral (ARV) meds control virus and help prevent transmission
+ Demographics
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Pathophysiology
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Pathophysiology cont.
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Case Study
■ Client name: E.S.

■ DOB: 4/4/66 (50 yo)

■ Sex: Male

■ Education: High School

■ Occupation: Janitor

■ Hours of work: Monday-Friday 6 am – 2 pm

■ Household members: Single, lives alone

■ Ethnic background: Caucasian

■ Referring physician: Sarah Maloney, MD

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Past Relevant Data
■ Pt. reports 71 pound wt. loss x 1 year, UBW=255#.

■ Pt. lives alone and reports smoking 1 PPD and drinks alcohol socially.

■ Pt. has no previous nutrition therapy.

■ Prefers eating out and dislikes to cook. Pt. states he “eats whatever he feels like.”

■ Surgical history of appendectomy.

■ History of diverticulosis.

■ Diagnosed with HIV ten years ago.

■ Medical regimen: fosamprenavir, ritonavir, truvada, co-trimoxazole,

clarithromycin and azithromycin, as well as multivitamin.
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Chief Complaint

■ Persistent fever
■ Fatigue
■ Decreased appetite
■ Diarrhea
■ Abdominal pain
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Anthropometrics
■ Height: 70” (5’10”)

■ Weight: 184 lbs (83.6kg)

■ BMI: 26.4 (overweight)

■ IBW: 160# (72.7kg)

■ %IBW: 115%

■ UBW: 255 lbs (115.9kg)—last recorded 1 year ago

■ %UBW: 115%

■ % Weight Change: 27.8% unintentional weight loss in 1 year (severe deficit)

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24 Hour recall

■ Breakfast: ham, egg and cheese on a plain bagel and small coffee with
cream and sugar

■ Lunch: too exhausted to eat

■ Snack 1 medium apple, 2 mini snickers bars and a large water.

■ Dinner – 5 oz baked chicken (legs and thighs), 1 cup white rice, 1 cup
cooked broccoli, 1 tbsp. butter and two 12 oz light beers.
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Dietary History
Consumed Estimated Needs

Energy 1,549 kcals/d 2,508-2,926 kcals/d

Protein 75g/d 125g/d

Fluid 1,064mL (primarily 2,058-2,926 mL/d

from alcohol)
Vitamin A 374 μg RAE 900 μg RAE

Calcium 472 mg 1000 mg

Vitamin D 1 μg 15 μg
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Pertinent Lab Values and Significance
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Medications Reviewed

■ Fosamprenavir: N/V, fatigue, abdominal pain

■ Ritonavir: loss of appetite, N/V/D, abdominal pain,
altered taste perception
■ Truvada: depression, N/V/D
■ Co-trimoxazole: Fever, depression
■ Clarithromycin: stomach pain, mild N/V/D, unpleasant
taste in mouth
■ Azithromycin: stomach pain, mild N/V/D, decreased
sense of taste
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Treatment Plan
■ Recommendation:

■ Energy: ref. Range: 30-35 kcal/kg – 2508-2926 kcal (repletion, combat

wasting)

■ Protein: 1.5g/kg – 125g/d (repletion)

■ Fluid:

■ ref range: 30-35 ml/kg—2,058-2926 mL fluid

*All needs calculated using current body weight for starting treatment and to
prevent over feeding.

Energy and protein needs based on current condition of symptomatic HIV/AIDS

with persistent fever
+ Diet Prescription
Breakfast - 1 cup Corn Flakes with ½ C milk
- ½ C Scrambled Eggs (Egg substitute)
-½ English Muffin
-1 T low sodium margarine
-1 medium plum

Snack -2 rice cakes

-1 T ricotta
- ½ C mango slices (drained and rinsed)

Lunch -1 94% lean hamburger patty

-1 bun
-Green salad with shredded carrots (1 C)
-1 T Balsamic Vinaigrette

Snack ¼ C Hummus
1 oz. unsalted pretzels

Dinner - 3 oz. lean pork chop

- 1 C white rice (boiled)
-1 T margarine
-½ C steamed green beans
¼ C black beans

Snack -1 T peanut butter (unsalted)

-1 medium apple (sliced)
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Nutrition Diagnosis

■ Inadequate energy intake as related to patient stating loss of appetite

secondary to progression of HIV/AIDS as evidenced by reported total daily
caloric intake of 1,549 kcals as compared to the recommended intake of
2,508-2926 kcals.

■ Inadequate protein intake as related to dx of progressive wasting with

HIV/AIDS and loss of appetite secondary to HIV/AIDS, as evidenced by intake
of 75 g/d compared to recommended 125 g/d and low prealbumin levels of 14
mg/dl and albumin levels of 3.3 mg/dl.

■ Inadequate Fluid Intake as related to 24-hour recall and S/S of water loss via
N/V/D as evidenced by intake of 1064 mL compared to recommended 2,058-
2926 mL.
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Intervention
■ Inadequate Energy Intake

■ Established Goal: Increase daily caloric intake to 2,508-2926 kcals/day.

■ Comprehensive Nutrition education focusing on:
■ Recommended modifications to meet daily caloric requirements to avoid a
catabolic state as a result of progression of HIV.
■ Provide basic understanding on a “nutrient-dense” diet with an emphasis on
high quality proteins to avoid protein energy malnutrition during
opportunistic infections.
■ Provide handout with “ foods to increase daily caloric intake
■ Introduce dietary recall methods to track calories throughout the day such as:
“Supertracker” or “MyFitnessPal”
■ Increase palatability of recommended foods through the addition of herbs,
seasoning
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Intervention cont.
■ Inadequate Protein Intake

■ Established Goal: Increase daily protein intake to 125 g/d

■ Comprehensive nutrition education focusing on maximizing protein at each
meal and increasing flavor in meats with seasonings.
■ Bulk food preparation to have ready to eat meals at will, while decrease
fatigue during food preparation and maximize ability to feed.
■ Recommend high calorie/high protein liquid shakes as tolerated.
■ 4-5 small, frequent, calorie dense meals.
■ Drink fluids in between each meal, stopping fluid consumption at least a half
hour before next meal.
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Intervention cont.
■ Inadequate Fluid Intake

■ Established Goal: Increase fluid intake to 2,508-2926 mL.

■ Recommend fluid modified diet of 2500 ml/day. Milk,
Juice and water all have to be apart of healthy diet.

■ Patient will drink 4 x 12oz water bottle (recommend

refillable 24oz bottle) to consume throughout the day.
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Monitoring
■ Monitoring/Evaluation:

■ 1. Labs to monitor
■ Albumin - monitor progression of malnourishment and catabolism.
■ BUN - monitor protein loss and catabolism
■ Creatinine - monitor protein loss and catabolism
■ HIV-1 RNA - monitor progression of infectious virus
■ Total T cells - monitor state of immunity response in relation to deterioration from HIV/AIDS

■ 2. RD to assess patient’s perceived level of difficulty of following lifestyle changes x 1 week and to make
modifications as needed

■ 3. Assess daily caloric intake via food diary in 3 weeks to see if patient is consuming at least 2508 kcal, 125 g
protein/d and 2500 mL of fluid.

■ 4. RD to monitor intake and tolerance to diet progression promoting diet tolerance and providing adequate
kcal and protein to prevent protein wasting x 3 weeks. Monitor Albumin, BUN and Creatinine.

■ 5. Patient will use a 24 oz refillable water bottle to consume twice per day. Patient will record in food diary
until next visit in one week the level of difficulty to consume this volume of water per day on a scale of 1-5
(No issue - difficult)
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Clinical Pearls-the key take aways
■ Intervention should focus on:
■ Treating wasting, catabolic state
■ Restoring nutrient balance
■ Restoring healthy body weight

■ The disease is a progressive autoimmune disorder that

exposes your pt to opportunistic infections

■ Many side effects and signs and symptoms are associated

■ Focus on managing symptoms and treat accordingly

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References
■ AIDS Global Statistics. (2015, November 25). Retrieved April 26, 2016, from https:
//www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/index.html

■ Gardner, C., & Campa, A. (2010). Nutrition Intervention and Human

Immunodeficiency Virus Infection, 110(7), 1105-1119. Retrieved April 26, 2016.

■ HIV Life Cycle. (2013, April 9). Retrieved April 26, 2016, from http://www.aidsinfonet.
org/fact_sheets/view/106

■ HIV/AIDS U.S. Statistics. (2014, December 2). Retrieved April 26, 2016, from https:
//www.aids.gov/hiv-aids-basics/hiv-aids-101/statistics/

■ The Stages of HIV Infection | HIV/AIDS Fact Sheets | Education Materials | AIDSinfo.
(2015, September 15). Retrieved April 26, 2016, from https://aidsinfo.nih.
gov/education-materials/fact-sheets/19/46/the-stages-of-hiv-infection