Nutrition in HIV
Which specific diagnostic procedures are recommended in HIV-infected patients with weight loss?
In addition to standard nutritional assessment the following points should be considered:
- Search for an opportunistic infection or other complications of disease or therapy.
- Determine testosterone, LH/FSH concentration
- Determine thyroid function and exclude treatment-induced diabetes mellitus.
- Look for signs of lipodystrophy (loss of subcutaneous fat, triceps skin fold thickness, waist/hip ratio).
- Nausea/vomiting: is this an adverse drug reaction?
- Exclude malassimilation/malabsorption.
- Is there a lack of saliva production?
- If abdominal pain or dysphagia: suspect candida oesophagitis
Start nutritional support while awaiting results of the diagnostic tests.
What are the indications for nutritional support or EN in HIV?
Nutritional therapy is indicated when significant weight loss (>5% in 3 months) or a significant loss of Body Cell Mass (>5% in 3 months) has occurred. In addition, nutritional therapy should be considered when the BMI is <18.5 kg/m2
EN is not contraindicated in pts with diarrhoea or malabsorption. MCT containing formulae are advantageous in pts with diarrhoea and severe malnutrition.
What is the role of anabolic drug treatment in HIV associated undernutrition?
Drug treatment and EN may complement each other. HIV positive patients with testosterone deficiency should receive testosterone substitution to restore muscle mass. Moderate gain in body weight and fat free mass can be achieved by recombinant human growth hormone (rhGH) at high cost.
Discuss PEG and HIV?
Local infections, with or without limited peritonitis, have been observed in HIV patients with PEG feeding more often than in other populations. Thus antibiotic prophylaxis is recommended.
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