Guidelines for Nutrition Support in AIDS

By Probart, Claudia K. | Journal of School Health, April 1989 | Go to article overview

Guidelines for Nutrition Support in AIDS


Probart, Claudia K., Journal of School Health


Guidelines for Nutrition Support in AIDS

While health professionals generally acknowledge the importance of proper nutrition for individuals with AIDS, national attention has focused primarily on developing drug therapies to combat the disease. Consequently, limited clinical data exist concerning specific nutritional needs of AIDS patients. However, nutrition problems may further complicate a weakened immune system and aggravate the effects of opportunistic infections. Moreover, many AIDS patients follow unsound, unproven dietary practices, thereby complicating treatment.

In response to this need, a Task Force on Nutrition Support in AIDS was formed to address the importance of proper nutrition for AIDS patients. Funded by a grant from Norwich Eaton Pharmaceuticals, Inc., the task force conducted a survey of current nutrition support practices regarding AIDS, and formulated extensive guidelines for such support.

According to the survey, more than 93% of health professionals involved in AIDS management consider nutrition important, yet fewer than 20% of treatment facilities reported a standard nutrition protocol for AIDS patients. Some 44% of hospitalized AIDS patients receive no nutrition support, and 52% are discharged without nutrition support. Likewise, though potential infection from total parenteral nutrition was a concern for 60% of respondents, the survey indicated 33% of hospitalized AIDS patients receive total parenteral nutrition rather than an enteral formula.

Following completion of the survey, the task force of researchers and practitioners who specialize in nutrition and AIDS treatment convened to develop guidelines for appropriate nutrition intervention at each stage of AIDS, addressing the entire course of the disease. Recommendations were offered to mitigate signs and symptoms such as diarrhea, nausea, vomiting, mouth and esophageal sores, infection, anorexia, and neurological disease. The complete guidelines were published in the January/February 1989 issue of Nutrition: An International Journal of Applied and Basic Nutritional Science, 1989;5(1):39-46. Highlights from the report are presented.

REPORT HIGHLIGHTS

Malnutrition and Immunity

Studies of undernourished children and adults demonstrated that malnutrition reduces the effectiveness of the immune system, making the patient more susceptible to a variety of infections. Patients with AIDS who are malnourished may develop infectious complications more quickly than well-nourished patients. Thus, restoring nutritional status may be a useful adjunct to therapy for individuals with AIDS. Individuals with Protein-Calorie Malnutrition, particularly those with AIDS, often experience intestinal damage, severe weight loss, and diarrhea. A cycle of weight loss and worsening malnutrition develops, which can exacerbate infection. If diarrhea also is involved, nutritional losses tend to be greater.

Gastrointestinal Complications

The gastrointestinal tract is a major target organ in AIDS. Complications resulting from AIDS-related infections, particularly those involving the gastrointestinal tract, can prevent a person with AIDS from getting adequate nutrition. Significant weight loss is common in the AIDS disease process. It is not unusual for individuals to lose 20%-30% of their usual body weight. A drop in weight of more than 30% can be fatal. Many factors contribute to weight loss, including oral/esophageal complications, diarrhea and malabsorption, anorexia, and psychosocial factors. These complications, which may result from infections or in response to drug therapy, have a direct, negative impact on nutritional status.

Oral/Esophageal Complications. Oral candidiasis (thrush), a thin film which covers the tongue, is caused by a fungal infection and afflicts 95% of individuals with AIDS. Mouth sores, also caused by opportunistic infections, can make chewing painful. …

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