Nutritional Assessment in HIV Infection
Jül L. Gerrior, RD, and Lisa M. Neff, MD
Nutrition assessment is a vital component of the general care of HIV-infected adults. With access to highly active antiretroviral therapy (HAART), HIV infection has become a chronic, manageable disease. Nutritional and metabolic complications traditionally associated with HIV infection such as hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, and weight loss continue to occur. However, emerging abnormalities such as regional alterations in body shape (fat redistribution syndrome or HIV-associated lipodystrophy), increasing body weight, high levels of low-density lipoprotein (LDL) cholesterol, insulin resistance, and other metabolic derangements may also be present. In addition, as patients are living longer, they may be susceptible to other age-related diseases such as diabetes, cardiovascular disease, and obesity. In this article, we review strategies for nutrition assessment and management in HIV-infected adults. Attention is focused on specific symptoms such as weight loss and diarrhea and specific disorders such as lipodystrophy, micronutrient deficiencies, and dyslipidemia, which commonly affect HIV-infected individuals. Proper attention to nutritional status may help to reduce the burden of disease and promote an enhanced quality of life in HIV-infected individuals.
Nutr Clin Care. 2005:8:6–15
© International Life Sciences Institute 2005
Micronutrients and HIV Disease: A Review Pre- and Post-HAART
Jane S. Lanzillotti, MSc, RD, CDE, and Alice M. Tang, PhD
Low serum micronutrient levels are common in HIV-positive individuals and have been associated with immune impairment, HIV disease progression, and increased mortality. Studies of micronutrient supplementation have yielded conflicting results, although several large trials suggest that multivitamin supplements, but not vitamin A, may decrease morbidity and mortality in some HIV-positive populations. Studies also suggest that antioxidant supplementation may decrease markers of oxidative stress in individuals with HIV, while selenium may enhance immune function by modulating cytokine production. Clearly, more research is needed, but current knowledge supports the use of a multivitamin supplement as a low-cost adjunct to antiretroviral treatment.
Nutr Clin Care. 2005:8:16–23
© International Life Sciences Institute 2005
Role of Omega-3 Fatty Acids in the Prevention of Disease Complications in Patients with HIV
Margo N. Woods, DSc
Hypertriglyceridemia and insulin resistance have been seen in patients with HIV. Beneficial effects of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been reported for these conditions. One study of n-3 fatty acid supplementation in patients with HIV reported a decrease in serum triglyceride levels. These marine fatty acids appear to be working at a number of sites to achieve an improvement in lipid metabolism and insulin sensitivity. There is disagreement about the amount of n-3 fatty acids needed to achieve different effects and about the optimal ratio of dietary n-6 and n-3 fatty acids.
Nutr Clin Care. 2005;8:4–30
© International Life Sciences Institute 2005
The Role of Nutrition in Fat Deposition and Fat Atrophy in Patients with HIV
Kimberly R. Dong, MS, RD, and Kristy M. Hendricks, ScD, RD
HIV-associated body shape changes and metabolic abnormalities, called HIV-associated lipodystrophy, are being seen with increased frequency. These issues may be associated with an increased risk of other diseases, such as cardiovascular disease, or with poor adherence to antiretroviral medications. Diet may be useful in the prevention and treatment of lipodystrophy and is a cost-effective and non-toxic intervention. At present, there are limited data on nutrition and HIV-related body shape changes. The purpose of this article is to review the roles that diet may play in the development and treatment of fat deposition and fat atrophy.
Nutr Clin Care. 2005:8:31–36
© International Life Sciences Institute 2005
Dietary Intake in HIV-positive Persons with and without Malabsorption
Kristy M. Hendricks, DSc, RD, Rachel Laferriere, MS, RD, Robert Houser, PhD, and Tamsin Knox, MD, MPH
This review examines the relationship among malabsorption, diarrhea, dietary intake, and body composition in an outpatient cohort of individuals with HIV infection. Twenty-three percent of the participants had malabsorption. Malabsorption was not associated with the presence of current or chronic diarrhea. In this “healthy” HIV cohort with a mean body-mass index (BMI) of 25 kg/m2, the presence of malabsorption did not have adverse nutritional outcomes in terms of body weight, lean body mass, hemoglobin, or albumin. The diets of those with or without malabsorption did not meet the goals of the Dietary Guidelines for Americans. Median dietary intake was high in percentage of total fat and saturated fat and low in total fiber intake and some key micronutrients.
Nutr Clin Care. 2005:8:37–43
© International Life Sciences Institute 2005
Nutrition and HIV in the International Setting
Christine A. Wanke, MD
HIV infection has become increasingly prevalent globally, with more than 40 million infected individuals, the majority of whom live in the resource-limited world, especially sub-Saharan Africa and Asia. There are nutritional and metabolic issues that significantly impact morbidity and mortality in HIV-infected populations. In addition, malnutrition has been associated with an increased risk of transmission of HIV from infected mothers to infants, and it may further compromise HIV-infected individuals who have tuberculosis or persistent diarrheal disease. The introduction of highly active antiretroviral therapy will have a significant impact on the mortality of HIV, but will not completely alleviate the malnutrition associated with HIV infection in the global setting.
Nutr Clin Care. 2005:8:44–48
© International Life Sciences Institute 2005