HIV/AIDS

CLNU 640 Dr. Martin

HIV and AIDS

Human Immunodeficiency Virus Acquired Immune Deficiency Syndrome

Objectives
De ine HIV/AIDS Understand t!e r"#e " t!e dietitian in HIV/AIDS treat$ent Deter$ine t!e n%triti"n c"$&#icati"ns ass"ciated 'it!

HIV/AIDS

(ec")ni*e criteria "r AIDS 'astin) Deve#"& strate)ies "r s+$&t"$ $ana)e$ent

,resence " HIV/AIDS -"r#d'ide

An esti$ated .0/.6 $i##i"n &ers"ns are #ivin) 'it! HIV as " 0001

2"int United Nati"ns ,r")ra$$e "n HIV/AIDS. 32%#+ 00045. 2008 Report on the global AIDS epidemic. http://data.unaids.org/pub/GlobalReport/2008/GR08_200 _!I"#re$%all&ap_GR08_en.'pg

HIV/AIDS C#assi icati"n

HIV/AIDS disease &at!'a+

Ac6%ired i$$%n"de icienc+ s+ndr"$e 3AIDS5 invades and

destr"+s !e#&er 7 #+$&!"c+te.

(es%#ts in t!e a ected &ers"n s%sce&tib#e t" in ecti"ns.

!I" is an R(A $irus that belongs to a class o) $iruses called

retro$iruses.
Vira# (NA and en*+$e reverse transcri&tase are s%rr"%nded b+

a &r"tein c"at 3ca&sid58 '!ic! is t!e c"re " t!e vir%s.

7!e c"$&"siti"n " t!e vira# enve#"&e is c"$&"sed " t'" #a+ers

" #i&id $"#ec%#es.

Ac6%ired r"$ '!en t!e vir%s b%dded r"$ t!e in ected ce## $e$brane.

HIV/AIDS disease &at!'a+

CD4 &r"tein is t!e tar)et " t!e vir%s and &resents itse# "n t!e ce##

$e$brane " !e#&er 7 #+$&!"c+tes.

CD4 &resents itse# "n t!e ce## $e$brane " $"n"c+tes8 $acr"&!a)es8 #+$&!

n"des and 'it!in t!e centra# nerv"%s s+ste$ as 'e##.

CD4 &r"tein9s %ncti"n is t!e rece&t"r "r t!e vir%s.

7!e vir%s attac!es b+ its )& :00 s%r ace &r"tein.

7!e bindin) " t!e vir%s t" t!e ce## ca%ses t!e vir%s enve#"&e t" %se t"

t!e ce## $e$brane a##"'in) t!e vir%s t" enter t!e ce##.
7!e vir%s &r"d%ces a DNA c"&+ " its "'n (NA )enetic $ateria#

t!r"%)! reverse transcri&tase inside t!e ce##.

7!r"%)! HIV inte)rase8 t!e DNA9s c"&+ " )enetic $ateria# is inserted t" t!e ce##. Vira# )enes direct asse$b#+ " $"re vir%s.

HIV/AIDS disease &at!'a+

HIV &r"tease &%t t")et!er c%t vira# &r"teins s%rr"%ndin)

v(NA.
7!is "r$s t!e vir%s &artic#es t!at b%d r"$ t!e in ected ce##s.

;%ddin) " vir%s &artic#es bec"$e c"ated b+ &art " t!e

in ected ce## $e$brane.

7!ese vir%s &artic#es attac< "t!er ce##s t!r"%)!"%t t!e b"d+. He#&er 7 #+$&!"c+tes are da$a)e.

M"n"c+tes are resistant and s%rvive.

Vir%s c"ntin%es t" re&#icate 'it!in. 7rans&"rt vir%s t!r"%)!"%t t!e b"d+.

Sta)es " HIV (e&#icati"n c+c#e

;r"<en D"'n and Si$&#i ied

HIV is a (etr"vir%s
Retroviruses:
C"ntain (NA

,r"d%ce a DNA ana#") " t!eir (NA Have an en*+$e <n"'n as (everse

7ranscri&tase

(everse 7ranscri&tase
C"&ies " t!e vir%s9 )enetic in "r$ati"n

"r$ (NA t" DNA t" &r"d%ce ne' vir%s

Hi)!#+ err"r &r"ne ,r"d%ces $%tant strains " vir%s t!at are

resistant t" dr%)s

HIV !as ? i$&"rtant =enes

Structural Proteins: =A= ,OL >NV

Regulatory Proteins: tat rev

Accessory Proteins: vi ne v&r v&%

Attac!$ent t" L+$&!"c+te

Attac!es t" rece&t"rs "n 7/ce##s CD4 rece&t"r and 1/trans$e$brane HIV vir%s %ses 'it! ce## $e$brane Vira# c"ntents e$&t+ int" ce##

(everse 7ranscri&tase
An en*+$e t!at is &art " HIV8 reverse

transcri&tase8 transcribes t!e (NA int" DNA

On#+ DNA can enter int" t!e n%c#e%s " t!e

7/ce##
(everse transcri&tase is !i)!#+ err"r

&r"ne/MU7A7IONS
A@78 .7C8 d478 ddc and dd#

Inte)rati"n
DNA " HIV inserts itse# int" t!e !"st

ce##9s DNA
Vir%s a#s" !as an en*+$e Ainte)rase9 t!at

assists 'it! t!is

7!e inte)rated DNA is n"' ca##ed a

A&r"vir%s9

7ranscri&ti"n
7!e 7/ce## transcribes t!e vira# DNA8

res%#tin) in t!e &r"d%cti"n " $%#ti&#e c"&ies " vira# (NA

7!is (NA c"des "r t!e &r"d%cti"n "

vira# &r"teins and en*+$es 3? )enes5

7rans#ati"n
Once t!e 7/ce##s !ave &r"d%ced vira#

(NA8 t!e (NA is ab#e t" &r"d%ce t!e &r"teins it needs 3trans#ati"n5
,r"d%cti"n " str%ct%ra# &r"teins8 c"re

&r"teins8 reverse transcri&tase8 inte)rase and &r"tease

Vira# ,r"tease
7!e &r"teins &r"d%ced b+ t!e vira# (NA

are in ver+ #"n) c!ains " &"#+&e&tides

;e "re t!ese &r"teins can bec"$e

%ncti"na#8 t!e+ need t" be c%t %&8 s" t!e vira# &r"tease en*+$e is %sed
,r"tease in!ibit"rs

Asse$b#+ and ;%ddin)

Vira# (NA and its &r"teins are read+ t"

)" in ect "t!er ce##s

It b%ds "

r"$ t!e 7/ce##8 ta<in) s"$e " t!e s%r ace vira# &r"teins 'it! it

7!e ne' vir%s c"%#d !ave ne' eat%res

AIDS
C#ic< ic"n t" add &ict%re

The Clinical

anifestations of HIV

AIDS Case de initi"n

M%st !aveB
HIV antib"dies

ANDB
C000 7/ce## c"%nt O(B One " t!e "&&"rt%nistic in ecti"ns "r diseases

3inc#%din) &%#$"nar+ 7;8 invasive cervica# cancer8 rec%rrent &ne%$"nia5

7rans$issi"n
(e6%ires c#"se c"ntact. HIV can be trans$itted t!r"%)! "%r di erent t+&es "

#%ids t!at can enter t!e b#""dstrea$

:. ;#""d 0. Se$en .. Va)ina# #%ids 4. ;reast $i#< 3$"t!er5 "r in %ter"

7ar)eted )r"%&s and &"&%#ati"ns

At ris< "r HIV/AIDSB
Heter"seD%a#s 'it! $"re t!an "ne seD &artner He$"&!i#iacsEinabi#it+ t" c#"t b#""d 7!ese &e"&#e !ave $an+ b#""d trans %si"ns. H"$"seD%a# "r biseD%a# $a#es Intraven"%s dr%) %sers In ants 'it! HIV/&"sitive $"t!ers

Min"rities are dis&r"&"rti"nate#+ a ected b+ HIV/AIDS8 es&ecia##+

A rican A$erican $en "##"'ed b+ His&anic/Latin" $en.

Hea#t! dis&arities bet'een ec"n"$ic c#asses are %e#in) t!e

e&ide$ic.

H"' is HIV dia)n"sedF

A&&r"ved GDA Screenin) 7ests >LISAB >n*+$e8 Lin<ed8 I$$%ne8 S"rbent8 Assa+5
Standardi*ed/!i)!#+ re&r"d%cib#e Gast 30.H/4 !rs5

-estern ;#"t 7est

M"re acc%rate t!an >LISA b%t n"t :00I L"n)er t" r%n 3:0/04 !rs5 M"re eD&ensive

,"#+$erase C!ain (eacti"n

Detects vira# n%c#eic acid in vir%s8 t!ere "re it can be %sed be "re an antib"d+ res&"nse is deve#"&ed Acc%rate "r babies b"rn t" HIVJ $"t!ers

(a&id 7estin)
(es%#ts in H/.0 $in%tes

H"$e 7estin)
Lance in)er and &%t sa$&#e "n a cardK $ai# int" #ab

CD4J ce## c"%nt8 vira# #"ad and resistance testin)

C#inica# C"%rse " HIV in ecti"n

Acute Phase:
!Stage "#

Si)ns and s+$&t"$s a&&ear : t" 4 'ee<s a ter eD&"s%re. -ei)!t #"ss8 ever8 ati)%e8 ras!8 !eadac!e8 s"re t!r"at8

$%sc#e &ain8 s'"##en #+$&! n"des8 #%#i<e s+$&t"$s.

Vir%s #eve#s are eDtre$e#+ !i)!.
Can be $"re t!an :80008000 c"&ies/$L

Last :/0 'ee<s.

C#inica# C"%rse " Hiv in ecti"n

$atency !Asym%tomatic# Phase:
!Stage &#

NO si)ns and s+$&t"$s " disease. Ma+ eD&erience &ersistent )enera#i*ed #+$&!aden"&at!+

3,=L5.
HIV c"ntin%es t" re&#icate. Can #ast a e' +ears t" $"re t!an a decade.

CD4J 7/ce## c"%nts )rad%a##+ a## r"$ t!e n"r$a# ran)e

" 400 t" :8000 c"&ies/$L t" 000/400 c"&ies/$L in t!is sta)e.

C#inica# c"%rse " !iv in ecti"n

Advanced HIV Disease ' AIDS
!Stage (#

,(OGOUND I$$%ne D+s %ncti"n. L"' CD4 C"%nt C000 c"&ies/$L "r an AIDS

de inin) i##ness.
Ni)!t s'eats8 #"ss " a&&etite8 'ei)!t #"ss8 ever8

ras!8 ati)%e.
C!ances " "&&"rt%nistic in ecti"ns and deat!

increases.

HIV Dr%) 7reat$ent

7ri&#e t!era&+8 Hi)!#+ active retr"vira# t!era&+ 3HAA(758

c"$binati"n t!era&+
(ed%ces vira# #eve#s t" a tin+ a$"%nt -"r< at di erent sta)es " t!e HIV #i e c+c#e Idea##+ start treat$ent at 4/H +ears " in ecti"n Idea##+ be "re CD4 c"%nt dr"&s t" 000 "r #ess Av"id "&&"rt%nistic in ecti"n

,r"tease in!ibit"rs
In!ibit &r"tease8 '!ic! is t!e di)estive en*+$e t!at

brea<s d"'n &r"tein.

HIV &r"tease is "n#+ "ne " severa# en*+$es t!e vir%s

%ses t" re&r"d%ce itse# . C%ts %& #"n) c!ains " &r"teins int" s$a##er &ieces t!at can )" and in ect "t!er ce##s.
-"r<s at t!e end " t!e c+c#eK ver+ &"tent s" t!ere are

side e ects. CriDican 3indinavir5.

-!en d"es treat$ent n"t '"r<F

A#read+ resistant t" "ne "r $"re " t!e dr%)s 7!e re)i$en $a+ be t"" di ic%#t t" "##"' One "r $"re " t!e dr%)s n"r abs"rbed &r"&er#+ 3&r"tein

bindin) and dr%) $"nit"rin)5

C"$binati"n n"t &"tent en"%)! Side e ects t"" di ic%#t t" bear

Medica# N%triti"n t!era&+ "r HIV/Aids

)utrition Assessment

N%triti"n Assess$ent
Diet History:
Decreased n%trient inta<e is t!e &ri$ar+ act"r

ass"ciated 'it! 'ei)!t #"ss.

Initia# screenin) and "##"' %& assess$ents are

i$&"rtant.

Identi + ris< act"rs s%c! as access t" ""d.

C"$&are act%a# ""d inta<e vs. esti$ated needs.

Deter$ine c"%nse#in) needs.

>sti$ati"n " ade6%ate $acr"/$icr" n%trients.

N%triti"n assess$ent
edical History:
C"nsider &ast and c%rrent in "r$ati"n and de)ree " i$$%ne

d+s %ncti"n.
Ma+ inc#%de a$i#+ !ist"r+ " diabetes8 CVD8 cancers and rena# disease8

!ist"r+ " s$"<in)/a#c"!"#/dr%) %se and $edicati"n/s%&&#e$ent %se.

C"nsider res%#tin) c"$&#icati"ns " HIV.

O&&"rt%nistic in ecti"ns and ne"&#as$sB
,resent additi"na# n%triti"n c!a##en)es. >Dacerbate stress res&"nse.

C"nsider n%triti"n/re#ated s+$&t"$s t!at acc"$&an+ HIVB

An"reDia8 na%sea8 v"$itin)8 diarr!ea.

N%triti"n Assess$ent
*iochemical Assessment:
Ma+ inc#%de i$$%n"#")ic/!e$at"#")ic/#i&id &r" i#e8

#iver/rena# %ncti"n8 e#ectr"#+tes8 )#%c"se/ins%#in #eve#s and in #a$$at"r+ $ar<ers.

Di ic%#t t" inter&ret #ab va#%es %sed as $ar<ers "r

n%triti"n stat%s8 s%c! as a#b%$in.

Use tests t!at c"rre#ate n%triti"n stat%s t" t!e &er "r$ance "

"r)ans.

-!at is Ln"r$a#M "r eac! HIV &atient is %n<n"'n.

Hi)!#+ individ%a#i*ed.

,!+sica# Assess$ent
Physical Assessment:
Ant!r"&"$etric $eas%re$ents
-ei)!t and ;MI Mid/ar$8 'aist and t!i)! circ%$ erence 7rice&8 bice&8 abd"$ina# and t!i)! at/ "#ds ;i"e#ectrica# i$&edance and d%a# D/ra+ ana#+sis S<in8 !air8 e+es8 and "ra# cavit+ eva#%ati"n Ma+ inc#%de evidence " 'astin) "r a#terati"ns in b"d+ s!a&e

N%triti"n interventi"ns
S%ccess %# interventi"ns inc#%de &reservati"n8

re!abi#itati"n and en!ance$ent " n%triti"n "r &reventin) 'ei)!t #"ss8 i$&r"vin) ca#"ric inta<e and i$&r"vin) CD4 c"%nt and 6%a#it+ " #i e.
7!ese inv"#veB
N%triti"n s%&&"rt Activit+ and eDercise ,r"$&t and e ective treat$ent "r "&&"rt%nistic in ecti"ns and

ne"&#as$
C"ntr"# " s+$&t"$s and side e ect ,revent in ecti"%s disease r"$ %nnecessar+ ""d/b"rne i##nesses

>ner)+8 ,r"tein vita$in and Minera# (e6%ire$ents

Hi)! ener)+/!i)! &r"tein diet ,r"tein ran)e :.H/0.0 ) &r"tein/<) and .H/4H <ca#/<) "r

re&#eti"n
:.0/:.4 ) &r"tein/<) "r $aintenanceB (ec"$$endati"ns $a+ increase 'it! ever8 &ne%$"nia and

in ecti"n
.H/40 cc/<) rec"$$endati"n ran)e "r 'ater Ma#abs"r&ti"n and diarr!eaB ,r"vide #"' at diet Micr"n%trient de icienciesB *inc 8se#eni%$8 vita$in ;68 ;:08 A

and >K direct#+ ass"ciated 'it! 'astin)

7!e ;"d+9s Stress res&"nse t" HIV/Aids

H+&er$etab"#is$ " ener)+ S!%ntin) " Ac%te ,!ase ,r"teins >nd"crine &ancreatic d+s %ncti"n De&#eted ce##%#ar anti"Didant st"res Increased "Didative stress Intestina# ne%r"&at!+

N%triti"na# C"$&#icati"ns
O&&"rt%nistic in ecti"nsB
"ra# candidiasis8 cirr!"sis "r !e&at"ce##%#ar carcin"$as.

=astr"intestina# n%triti"na# c"$&#icati"nsB

diarr!ea8 #i&"d+str"!+8 $a#abs"r&ti"n and $a#n%triti"n.

-ei)!t #"ss and 'astin)B

red%ces "ra# inta<e #"ss " at/ ree and #ean b"d+ $ass decreased a&&etite and ""d inta<e $"%t! s"res8 taste a#terati"ns8 and di ic%#t+ c!e'in)/s'a##"'in) ins%#in resistance8 diabetes8 rena# i$&air$ent8 !+&ertensi"n8 $etab"#ic s+ndr"$e ane$ia !erb/dr%)/n%trient interacti"ns

Ne%r"#")ica# dis"rders can ca%se $"t"r i$&air$ent and de$entia8 '!ic! can

#ead t" inade6%ate n%triti"n.

Decreased "ra# sens"r+ &erce&ti"n can increase ris< " as&irati"n '!i#e

s'a##"'in).

O&&"rt%nistic In ecti"ns
Candidiasis " br"nc!i8

trac!ea #%n)s8 es"&!a)ea#

HIV ence!&a#"&at!+ L+$&!"$a Sa#$"ne##a Se&tice$ia 7"D"&#as$"sis -astin) S+ndr"$e Na&"si9s Sarc"$a C"ccidi"id"$+c"sis

Cervica# Cancer Is"s&"r"sis Hist"&#as$"sis Her&es Si$&#eD Cr+&t""c"cc"sis Cr+&t"s&"ridi"sis L+$&!"$a Hist"&#as$"sis

M"nit"rin) and >va#%ati"n

C"ntin%"%s $"nit"rin) " &atient9s n%triti"n stat%s. C"ntin%"%s re/eva#%ati"n " &atient9s assess$ents and

interventi"n strate)ies.
In as+$&t"$atic sta)esB
assess$ent ever+ ./6 $"nt!s.

C"ntin%"%s %&datin) " c#inica# in "r$ati"n. C"ntin%"%s %&datin) " ed%cati"n needs. =ive &atient c"$&assi"n and s%&&"rt.

=OALS
,r"#"n) #i e and i$&r"ve t!e 6%a#it+ " #i e "r t!e #"n)

ter$.
,revent 'ei)!t #"ss. S%&&ress t!e vir%s t" as #"' a #eve# as &"ssib#e "r as

#"n) as &"ssib#e. Dr%) t!era&+.

O&ti$i*e and eDtend t!e %se %#ness " c%rrent#+ avai#ab#e

t!era&ies
Mini$i*e dr%) t"Dicit+ and $ana)e

side e ects

A Case St%d+ A&&r"ac!

Hiv/Aids Case St%d+

H0 +ear "#d Ca%casian $a#e recent#+ dia)n"sed 'it!

HIV d%rin) a !"s&ita# visit.

Hist"r+ " rena# cancer8 divertic%#"sis8 !+&er#i&ide$ia8

s#ee& a&nea8 and &anc+t"&enia

,ersistent ever8 diarr!ea8 and abd"$ina# &ain

Gacia# 'astin)8 #esi"ns MAC8 Nar&"si9s sarc"$a

,atient !ist"r+
Meds: G"sa$&renavir8 (it"navir8 7r%vada8 Si$vastatin8

,ravastatin8 ;%&r"&i"n8 (anitidine8 C"/tri$"Da*"#e8 C#arit!r"$+cin8 Vit ;:0 3:000$)5

Smoker: Oes Alcohol: Oes Labs: CD4P H ce##s/$$.8 -;CP 0?00%L8 LDLP 14$)/dL8 HDLP

.1$)/dL8 C!"#ester"# :H:$)/dL H)P :0.:)/dL8 7ri)#+cerides :H:$)/dL8 =#%c"seP ?4$)/dL8 vira# #"adP :80418?41c"&ies/$L.

N%triti"n Hist"r+
General: ,atient a&&etite is ON8 b%t n"t n"r$a#. ,atient

%s%a##+ eats t'" $ea#s &er da+.

S<i&s #%nc! d%e t" eD!a%sti"n U;-P 0H4 #bs C%rrent 'ei)!tP:44#bs.

Us%a# Dietar+ inta<e

Breakfast/lunch: ;rea< ast sand'ic! 3!a$8 e))8

c!eese.5 S$. c" ee '/ crea$ and s%)ar

Supper: Meat/H "* ba<ed c!ic<en8 : c%& rice8 :

c%& br"cc"#i8 : tbs b%tter

Snacks: A&&#e8 0 $ini cand+ bar8 'ater 3:6"*5

H"' is AIDS de inedF D"es t!is &atient it t!e de initi"nF -!+F

Ac6%ired i$$%ne de icienc+ s+ndr"$e 3AIDS5 is de ined b+ t!e CDC as !avin) a CD4 c"%nt #ess t!an 000 ce##s/$$. and at #east "ne " t!e AIDS de inin) c"nditi"ns. 7!is &atient '"%#d be c!aracteri*ed as !avin) AIDS sec"ndar+ t" !avin) a CD4 c"%nt " H ce##s/$$. and t!ree AIDS/ de inin) c"nditi"nsB 'astin)8 MAC8 and Nar&"si9s sarc"$a.

SOA,
)ote

S%bjective S:
7L is a H0 +/" Ca%casian $a#e. HIV &"sitive b+ recent !"s&ita# ad$issi"n. ,atient n"t ab#e t" '"r< ri)!t n"' d%e t" brac!ia# &#eDis inj%r+. ,atient states !e ee#s eD!a%sted a## t!e ti$e and !as #"st a #"t " 'ei)!t. ,atient is a#ert and "riented. ,atient describes a&&etite as t'" $ea#s &er da+. Us%a##+ s<i&s #%nc!. (e&"rts %se " b"t! a#c"!"# and t"bacc". ,atient re&"rts ati)%e and diarr!ea "r t!e &ast severa# $"nt!s. ,atient re %ses ;IA.

Objective
O: D+: AIDS8 HAA(7 re)i$en.
Ht. 10in8 -t. :44 Ibs8 U;- 0H4 Ib8 ;MIB 06.. Meds: G"sa$&renavir8 (it"navir8 7r%vada8 Si$vastatin8 ,ravastatin8 ;%&r"&i"n8 (anitidine8 C"/ tri$"Da*"#e8 C#arit!r"$+cin8 Vit ;:0 3:000$)5 General appearance: 7!in8 Ca%casian $a#e '/ acia# 'astin)K #esi"ns. Labs: CD4P H ce##s/$$.8 -;CP 0?00%L8 LDLP 14$)/dL8 HDLP .1$)/dL8 C!"#ester"# :H:$)/dL H)P :0.:)/dL8 7ri)#+cerides :H:$)/dL8 =#%c"seP ?4$)/dL8 vira# #"adP :80418?41c"&ies/$L. ,hat micronutrients is this %atient at ris- for .ecoming deficient in secondary to his disease state/ C"$&ared 'it! HIV/ne)ative &ers"ns8 HIV/in ected &ers"ns !ave #"'er ser%$ c"ncentrati"ns " severa# $icr"n%trients and $"re c"$$"n#+ !ave $icr"n%trient de iciencies inc#%din) t!ia$ine8 se#eni%$8 *inc and Vita$ins A8 ;.8 ;68 ;:08 C8 D8 and >. 7!ese de iciencies !ave been ass"ciated 'it! aster disease &r")ressi"n8 "r HIV/re#ated $"rta#it+.

Assess$ent
A:
His 04/!"%r reca## revea#ed t!at &atient c"ns%$ed ab"%t :400 ca#"ries and 11 )ra$s " &r"tein. ,atient &resents 'ei)!t #"ss d%e t" &r")ressi"n " diseaseK #"ss " a&&etite. ,!+sica# eDa$ revea#ed )""d "ra# !ea#t!. A#tered re#ated n%triti"n #abs indicate &r")ressi"n " HIV. Main "bjective 'i## be t" &r"vide as $an+ ""d "&ti"ns "r t!e &atient t!at !e can t"#erate and 'i## #i<e 'it! n" restricti"ns. ,atient 'i## be &r"vided 'it! ""ds t!at are s" t and $"ist8 av"idin) s&ic+ "r acidic ""ds8 '!ic! are served at r""$ te$&erat%re "r c""#er. >d%cati"n "n re&"rted %se " $%#tivita$in8 vita$in > and C8 =insen)8 Mi#< 7!ist#e8 >c!inacea and St. 2"!ns -"rt. Interacti"ns 'it! t!ese !erba# s%&&#e$ents and $edicati"ns can ca%se adverse reacti"ns "r t!e &atient8 '!ic! can a%)$ent %nder#+in) s+$&t"$s a#read+ ass"ciated 'it! HIV. ,ould you recommend any vitamin or mineral su%%lements for this %atient/ A )enera# $%#tivita$inQ$inera# s%&&#e$ent c"%#d be rec"$$ended n"t t" eDceed :00I " t!e (DA

,#an
M"nit"r and eva#%ate "ra# eedin) strate)ies ,r"vide n%trient dense snac<s and &r"tein &"'ders 3ta<in) int" c"nsiderati"n

&atients ""d &re erences/t"#erances5.

>d%cate c#ient "n t!e &reventi"n " in ecti"%s disease r"$ %nnecessar+ ""d/

b"rne i##nesses.
7!e dietitian s!"%#d e$&!asi*e ""d sa et+ beca%se t!e &atient !as a c"$&r"$ised i$$%ne

s+ste$. -!en s!"&&in)8 e$&!asi*e c!ec<in) eD&irati"n dates and n"t &%rc!asin) cans t!at are dented8 #ea<in)8 "r b%#)in) -!en &re&arin) ""d8 $a<e s%re t" a#'a+s 'as! t!e !ands be "re &re&arin) and eatin) ""ds. Av"id cr"ss c"nta$inati"n 'it! ""ds. >d%cate &atient "n n"t c"ns%$in) an+ %nderc""<ed "r ra' $eat8 e))s8 &"%#tr+8 is!8 "r s!e## is!. Gina##+ $a<e s%re t!at ""ds are st"red &r"&er#+ and and d" n"t eat ""ds t!at !ave been in t!e re ri)erat"r "r $"re t!an t!ree da+s. A#s"8 av"id sa#ad bars '!en eatin) "%t. ;"i# 'ater and #et it c""# i drin<in) r"$ t!e a%cet "r %se b"tt#ed 'ater
C"%nse# and ed%cate

"n t!e e ects " a#c"!"#8 !erba# and vita$in/$inera# s%&&#e$ents re)ardin) &"ssib#e interacti"ns 'it! HIV HAA(7 t!era&+.

,>S State$ent/="a#
P0S Statement: Unintended 'ei)!t #"ss re#ated t"

decreased abi#it+ t" c"ns%$e s% icient ener)+ as evidenced b+ 01I 'ei)!t #"ss in &ast +ear and HIV/AIDS dia)n"sis.
1oal: stabi#i*e 'ei)!tK increase n%trient/ ""d inta<e8

&revent de!+drati"n8 rec"$$end ""ds t" red%ce =I %&set.

(e erences
:. Ne#$s8 M. 300::5. N%triti"n 7!era&+ R ,at!"&!+si"#")+ 0nd editi"n. ;e#$"ntB -ads'"rt! Cen)a)e Learnin)K C!a&ter 04. 0. Ma!an8 >sc"tt/St%$&. 300045. Nra%se9s G""d8 N%triti"n R Diet 7!era&+8 ::t! >d.8 -; Sa%ndersK C!a&ter 4:. .. >$er+ >. 300:05 C#inica# Case St%dies "r t!e N%triti"n Care ,r"cess. ;%r#in)t"n8 MA. 2"nes R ;art#ett Learnin)K 4. >sc"tt/St%$& S. 300015. N%triti"n and Dia)n"sis/(e#ated Care. 6t! editi"n. Li&&inc"tt -i##ia$s R -i#<insK Lab Va#%e IndeD. H. ,"rt!8 Car"# Matts"n. 300:05. >ssentia#s " ,at!"&!+si"#")+ .rd ed. ,!i#ade#&!ia8 ,A8 Li&&inc"tt8 -i##ia$s R -i#<insK C!a&ter :6. 6. CDC HIV Incidence/,reva#ence. 300::5. Accessed r"$ t!e -"r#d -ide -eb. !tt&B//'''.cdc.)"v/!iv/t"&ics/s%rvei##ance/incidence.!t$ 1. NIAID 3000?5. Accessed r"$ t!e -"r#d -ide -ebB !tt&B//'''.niaid.ni!.)"v/7O,ICS/HIVAIDS/UND>(S7ANDIN=/,a)es/s+$&t"$s.as&D