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Nutrition Intervention Needed in Care of Persons with HIV

Position of the American Dietetic Association and Dietitians of Canada

FOR IMMEDIATE RELEASE

June 12, 2000

Contact: Bridget McManamon, Lori Ferme

800/877-1600 ext. 4769, 4802

(Please do not publish these numbers.)

CHICAGO - The American Dietetic Association and Dietitians of Canada announced that nutrition intervention should be part of a total health care plan for persons with human immunodeficiency virus (HIV). The position paper is published in the June 2000 issue of the Journal of The American Dietetic Association and the Canadian Journal of Dietetic Practice and Research.

The statement purports that efforts to optimize nutritional status, including medical nutrition therapy and nutrition-related education, should be components of the total health care provided to people with HIV.

"Identifying the nutritional needs of HIV patients early on is crucial to successful prevention and treatment," said registered dietitian Dr. Keith Ayoob, ADA spokesperson and contributing author of the position paper. "Allowing dietitians to screen for nutritional status is a strategic part of early intervention efforts to prevent the loss of essential body tissues."

An estimated 16.3 million people have died of AIDS-related complications to date, a total that includes approximately 6.2 million women and 3.6 million children.* HIV attacks the immune system, making an infected person prone to illness. Malnutrition can make an infected person even more susceptible to infection and reduce the efficacy and tolerance to medications and other therapies. By combining nutrition intervention with medication therapy, they can work together to manage disease and improve the effectiveness of treatment by preserving vital organ and muscle tissues.

Medical nutrition therapy in HIV disease includes early assessment and treatment of nutrient deficiencies, maintenance and restoration of lean body mass and support for activities of daily living and quality of life.

"Dietitians are a valuable and essential resource for primary health care providers and other members of the health care team in identifying risk factors for malnutrition," said Ayoob. "It is important to establish realistic and individualized nutrition goals that fall in line with the goals of the overall health care plan."

HIV POSITION PAPER/ADD ONE

A complete nutrition care plan is developed for the patient addressing the problems identified in the initial nutrition assessment and outlining plans for monitoring and adjusting interventions. Continued nutrition therapy is crucial as medication regimens may change which in turn can affect nutritional status.

Children and adolescents infected with HIV are at greater risk for disease complications and should have a full nutrition evaluation as soon as possible after the diagnosis of HIV infection. These children may suffer from growth failure, failure-to-thrive, developmental delay and malnutrition due to their immature immune systems and the immune-suppressing effects of HIV.

"Nutrition education and counseling is a must for both the patient and the primary caregiver," said Ayoob. " It is important that children and adolescents learn to make appropriate food choices, especially when eating outside the home, with peers or in other social situations. In addition, many children and adolescents rebel against taking medications and adhering to meal schedules. It is necessary to stress the importance of following the prescribed medication and nutrition regimen."

Recommended counseling guidelines include education on the following:

• Adequate nutrient intake;
• Recommended portion sizes;
• Food and water safety issues;
• Perinatal nutrition and breast-feeding issues;
• Nutrition strategies for symptom management such as swallowing problems, anorexia, thrush and other barriers to food intake;
• Food-medication interactions including meal timing and foods to emphasize or avoid to reduce unwanted interactions;
• Psychosocial and economic issues;
• Alternative feeding methods (supplementation or tube feeding);
• Guidelines for evaluating nutrition information.

"All of the guidelines are important, but dietitians pay extra attention to educating patients on food and water safety, since HIV-infected people are more susceptible to foodborne illness," said Ayoob. "Dietitians also provide guidelines for evaluating nutrition-related complementary and alternative therapies so clients can make informed decisions about their use."

The 70,000-member American Dietetic Association is the world’s largest organization of food and nutrition professionals. The Chicago-based ADA serves the public by promoting optimal nutrition, health and well-being.

Dietitians of Canada represents 5,000 dietitians across Canada committed to promoting the health and well-being of consumers through food and nutrition.

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