HIV

Abella | Acopiado | Lat | Silverio | Tabalba

Objectives

Outline
I. Definition of terms II. Epidemiology III. Pathophysiology IV. Medical and Nutritional Assessment V. Management of HIV VI. Prevention

Medical and Nutritional Assessment

Tests to diagnose HIV infection

Test ELISA (enzyme-linked immunoabsorbent assay) Western Blot/Modified Western Blot Indirect Immunofluorescent Antibody Assay
(Nelms, et. al., 2011)

Description Detection of HIV antigen that is linked with an enzyme through addition of a catalyst Detection of specific HIV proteins in a given sample through gel electrophoresis Modification of sample to enable fluorescene of HIV antibody under UV light

Tests to diagnose HIV infection

Test Description Line Immunoassay (LIA) Measurement of antibodies to five HIV-1 antigens Radio Immunoprecipitation (RIPA) Polymerase Chain Reaction (PCR) Detection of low levels of antibodies through radiolabelled amino acids Amplification of single/few copies of pieces of DNA

(Nelms, et. al., 2011)

Clinical Staging of HIV/AIDS (WHO, 2005)

Categories Primary HIV infection Clinical Stage 1 Sample Criteria Acute retroviral syndrome; no complicating opportunistic infection/immune dysfunction Primarily asymptomatic; possible generalized lymphadenopathy Weight losses that are <10% of body weight, herpes zoster, minor mucocutaneous manifestations, recurrent bacterial upper respiratory tract infections, fungal infections of fingers, papular pruritic eruptions, or seborrhoeic dermatitis

Clinical Stage 2

(Nelms, et. al., 2011)

Clinical Staging of HIV/AIDS (WHO, 2005)

Categories Clinical Stage 3 Sample Criteria Weight loss of >10% of body weight, persistent constitutional symptoms (fever, diarrhea),oral candidiasis or hairy leukoplakia, acute necrotizing ulcerative gingivitis or necrotizing ulcerative periodontitis, pulmonary tuberculosis, severe bacterial infections, unexplained anemia, neutropenia, and/or thrombocytopenia for more than a month (confirmatory testing is required for anemias)

(Nelms, et. al., 2011)

Clinical Staging of HIV/AIDS (WHO, 2005)

Categories Clinical Stage 4 Sample Criteria HIV wasting syndrome (>10% weight loss with chronic diarrhea, weakness, fever), opportunistic events as described in Clinical Category 3, as well as chronic herpes simplex virus, recurrent severe or radiological bacterial pneumonia, pneumocystis pneumonia, Kaposis sarcoma, CMV, cryptosporidiosis, isosporiasis, any disseminated mycosis (e.g., coccidiomycosis, histoplasmosis, penicilliosis), recurrent non-typhoidal salmonella septicaemia, and/or lymphoma (cerebral or B cell non-Hodgkin)

(Nelms, et. al., 2011)

Food and Nutrition-Related Medication Interactions for Selected Antiretrovirals *insert summary of Table 24.5 in Nelms*

Nutritional Implications of Disease and Treatment

1. Protein turnover rates 2. Weight loss 3. Production of acute-phase proteins 4. Association between micronutrient levels and complications of immune impairment

Nutritional Implications of Disease and Treatment

1. Protein turnover rates Elevated, as with immune system activity Abnormal protein metabolism increased anabolic activity

Nutritional Implications of Disease and Treatment

2. Weight loss Starvation/marasmus Wasting

Nutritional Implications of Disease and Treatment

3. Production of acute-phase proteins Changes in macro- and micronutrient status:

Lower serum levels of Se, Zn, Mg, Ca, Fe, Mn, Cu, carotine, choline, glutathione, and vit A, B6, B12, E Elevated levels of folate, niacin, carnitine

Nutritional Implications of Disease and Treatment

4. Association between micronutrient levels and complications of immune impairment Low levels of B12 neurologic changes, bone marrow toxicity (zidovudine); accelerated progression of HIV Low levels of vit E and C oxidative stress conditions

Suggested criteria for the diagnosis of wasting in HIV disease

Parameter Weight loss BMI Criteria 10% loss over 12 months 7.5% loss over 6 months <20

Body cell mass

Men: 5% loss over 6 months or <35% of weight if BMI is less than 27 Women: <23% of weight if BMI is less than 27

Nutritional Implications of Selected Treatments for Opportunistic Events

*insert summary of Table 24.9 in Nelms*

Nutrition Assessment

Physical Assessment Biochemical Assessment Medical History Dietary Evaluation

Physical Assessment

Weight BMI Physical examination for clinical signs of deficiency and excess of macronutrients and micronutrients Anthropometry to characterize body composition and patterning (including body shape changes associated with lipodystrophy) Body composition analysis

Biochemical Assessment

Immunologic profile, hematologic profile, lipid profile, liver function, renal function, electrolytes, glucose and insulin levels; inflammatory marker

Selected Biochemical Measures in HIV Disease

*insert summary of Table 24.11 in Nelms*

Medical History

Past and current information on diagnoses and symptoms Family history of diabetes, cardiovascular diseases, cancers, and renal disease History of smoking, alcohol, and drug use; medication history and current profile (including herbal, supplement, and other complementary therapies)

Dietary Evaluation

Access to food; food consumption

Food resources o Intake analysis o Dietary counseling
o

Nutrition Diagnosis

increased energy expenditure inadequate food intake increased nutrient needs swallowing difficulty involuntary weight loss food-drug interactions