As of 2009, there were an estimated 33.3 million people worldwide living with HIV/AIDS. HIV/AIDS and nutrition are deeply connected. The symptoms of HIV infection can lead to malnutrition and malnutrition can speed the progress of the disease.
For those patients whose illnesses require hospitalization, optimal nutritional support is critical to the patient's quality of life. In order to become healthy enough to leave the hospital, malnutrition has to be identified and treated.
The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is an organization comprised of healthcare professionals representing the disciplines of medicine, nursing, pharmacy, dietetics, and nutrition science and offers guidelines for the nutritional support of HIV/AIDS patients.
Nutrition Screening
The first guideline for the nutritional support of HIV/AIDS patients is nutrition screening. In other words, is the patient malnourished? As noted, the symptoms of HIV can cause a patient to lose his or her appetite and become malnourished. A nutrition screening can determine if there are other conditions that could prevent the patient from obtaining the proper nutrition. A nutrition screening should be based on both objective data, such as height, weight, weight change and the primary diagnosis. Also, though, the nutrition screening should look at other factors, such as whether the patient is elderly, abuses drugs or alcohol, is clinically depressed or has another condition that might affect his or her ability or desire to eat.
Nutrition Assessment in Adults
Nutrition assessment differs from nutrition screening in the level of detail. A nutrition assessment is "a comprehensive approach to defining nutrition status that uses medical, nutrition, and medication histories; physical examination; and laboratory data." A nutrition assessment looks at things like the Body Mass Index of the patient, a physical examination of the musculoskeletal system, the patient's eating habits and gastrointestinal function and a complete blood workup. The laboratory analyses are important because often malnutrition doesn't manifest into clinical significance until an advanced stage of deficiency occurs.
Nutrition Assessment in Children
Children with HIV often show low birth weight and slow growth. Studies have shown that children with HIV are often more malnourished, even if they aren't underweight or growing poorly. This is largely because individuals with HIV have been shown to burn 10 percent more calories at rest than people who aren't infected with HIV. Also, HIV causes weight loss to come from lean muscle mass instead of fat. This loss of lean muscle mass is associated with higher rates of malnutrition, as it is the lean muscle mass that regulates the hormones that lead to appetite.
If an HIV infected child shows problems with growth, this is a poor indicator of survival. It is critical to do a complete nutrition assessment and determine if supplementation is necessary.
Nutritional Supplementation
There are two kinds of nutritional supplementation available to individuals who become malnourished and cannot eat sufficient amounts of food to support their nutritional needs. Paraenteral nutrition involves intravenous feeding that bypasses the normal digestive route. Enteral nutrition involves placing a feeding tube down the nose, stomach or small intestine and administering nutrition through the tube.
Clearly, these are unappealing options that are used as a last resort. A.S.P.E.N. and other leading health organizations promote nutrition education as a preventative measure. If patients with HIV/AIDS become educated on the dangers of malnutrition because of their illness, they can become more proactive in avoiding it.
