Basic HIV Course for Health Professionals Session

Importance of Nutrition Good nutrition can help:
people feel strong physically and mentally
strengthen the immune system to fight infection
people stay productive and physically able
prevent undernutrition
improve drug adherence and effectiveness
manage common symptoms of illness and drug side effects This Photo by Unknown Author is licensed under CC BY-SA<br>

Poor Nutrition Poor nutrition can:
Weaken the immune system
Increase vulnerability to infections
Reduce the body’s ability to recover from infections
Increase the risk of developing non-communicable diseases This Photo by Unknown Author is licensed under CC BY-NC-ND<br>

What are Some Consequences of Malnutrition in PLHIV and TB Clients? Poor food absorption
Poor growth
Increased morbidity
Metabolic complications
Increased risk of OIs
Reduced survival Increased cost of treating malnutrition-related illness
Increased risk of MTCT of HIV
Socioeconomic problems, e.g.:
food insecurity
poverty<br>

The Vicious Cycle between Undernutrition and HIV and/or TB<br>

Nutrition Assessment and Intervention<br>

Importance of Nutrition Assessment Identifies people at risk of malnutrition for early intervention or referral
Detects eating habits that increase disease risk
Identifies needs for nutrition education and counselling
Identifies local food resources
Tracks growth and weight trends
Establishes a framework for a Nutrition Care Plan<br>

Patients that are losing weight should be actively investigated and monitored until the cause is found or the weight loss resolves.
As a minimum, TB screening and a random blood glucose level should be performed.
Further investigations should be done as indicated by history and examination.
Refer any patients with documented ongoing weight loss without an obvious cause. Extrapulmonary TB or malignancies may need to be excluded
Weight Gain
Weight gain at an acceptable rate in a patient who has recently started ART is reassuring and usually indicates immune system recovery
However, PLHIV on ART for many years can have a higher risk for hypertension, diabetes and cardiovascular disease. Excessive weight gain should therefore be avoided. Nutritional Assessment<br>

General Guidelines for People Living with HIV and AIDS (1) Get individualised nutrition therapy, see dietitian for further assessment, counselling & nutrition support
Get screened for communicable and non-communicable diseases
Get weighed regularly and have weight recorded
Advise weight loss for overweight and obese patients
Regular balanced meals, with good portion control
Increased intake of high fibre foods<br>

General Guidelines for People Living with HIV and AIDS (2) Reduce amounts of unhealthy fats, salt, sweets, sugary foods and sugar containing beverages
Consider cultural, social and economic issues
Include physical activity as part of healthy lifestyle
Discourage smoking, alcohol consumption
Maintain good hygiene and sanitation
Prevent and seek early treatment for infections
Seek dietary advice on managing symptoms.
Take medicines and food as advised by provider<br>

South African Food Based Dietary Guidelines to Promote a Healthy Lifestyle Refer to pages 183 – 184 of your participant manual to see a chart with these guidelines<br>

Increased nutritional requirements in PLHIV In the presence of WHO stage 2 conditions or higher, PLHIV should increase their energy intake by 20-30% over the recommended energy intake levels of healthy, non-HIV-infected individuals of the same age, sex, and physical activity levels.
Good nutrition is best achieved by consuming a varied diet rich in micronutrients, especially vitamins A, B6, B12, selenium, iron, and zinc.
However, a daily multivitamin may provide nutrients in patients who are not able to get a complete or balanced diet, or those who have poor appetite, financial restraints, or other factors that may contribute to malnutrition<br>

Portion Control Tips (1) A meal should consist of:
one meat dish option
an option of vegetarian
for those who are vegetarian
one starch option
two vegetable options
one fruit option and
water<br>

Portion Control Tips (2)<br>

NOTE: Nutrition intervention is usually individualised based on patient requirements, medication, other complications etc. Thus, it is still critical that HIV and T.B clients are referred to a registered dietitian for individualised nutrition assessment and intervention.<br>

Key Learning Points HIV, nutritional status and immune function are linked
It is important to identify adults and children that are malnourished and refer them to dieticians for nutritional support
People that are infected with HIV have increased nutritional requirements
Nutritional advice can be given to people that experience symptoms of HIV or side effects from its treatment<br>

Nutrition Small Group Activity This Photo by Unknown Author is licensed under CC BY-SA<br>

Any Questions? Thank you!<br>