session 3: nutrition and hiv medications nutrition management with hiv and aids: practical tools for...

Session 3:Session 3:Nutrition and HIV MedicationsNutrition and HIV Medications

Nutrition Management with HIV and AIDS: Practical Tools for Health Workers

Session 3: Nutrition and HIV MedicationsNutrition Management with HIV and AIDS Training

Slide 2

ObjectivesObjectives

• Explain the importance of nutrition and HAART

• Identify food effect or potential side effect for each antiretroviral medication

• Counsel clients on food effects of medications by using the food-medication timetable


Slide 3

Why is Nutrition Important Why is Nutrition Important with Medications?with Medications?

• Improved treatment effectiveness and efficiency

• Prevention of side effects

• Better adherence, means less resistance

• Improved quality of life


Slide 4

Effects of Malnutrition and HIV on the Effects of Malnutrition and HIV on the Immune SystemImmune System

CD4 T-lymphocyte number

CD8 T-lymphocyte number

Skin sensitivity to infections

CD4 / CD8 ratio

Serologic response after immunizations

Bacteria killing

Good Nutrition

HAART

Malnutrition HIV


Slide 5

ARV vs. HAARTARV vs. HAART

• ARV:ARV: antiretroviral medication refers to the individual medications that are used to inhibit the multiplication of retroviruses like HIV

• HAART:HAART: highly active antiretroviral therapy refers to the treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and progress of HIV disease


Slide 6

Modern (New) TherapiesModern (New) Therapies

• HAART: combination of 3 or more of the following:• Non-nucleoside reverse transcriptase inhibitors

(NNRTIs)• Nucleoside reverse transcriptase inhibitors (NRTIs)• Protease Inhibitors (PIs)

• Therapies to treat opportunistic infections• Ex: TB treatment, antifungal, antibiotics

• Malaria treatment• Multivitamin/mineral supplements


Slide 7

Traditional TherapiesTraditional Therapies

• Herbal remedies, teas/infusion, or high-dose vitamin supplements

• Caution: some may interact with other medicines or foods• Ex: Avoid garlic supplements with Saquinavir

• Some therapies may be expensive, replace food, and can cause liver damage (especially if combined with other medications)• Always ask clients what traditional therapies they are

taking


Slide 8

Food and Medication InteractionsFood and Medication Interactions

• Food (affects) Medication absorption, metabolism, distribution, and excretion

• Medication (affects) Nutrient absorption, metabolism, distribution, and excretion

• Medications’ (affects) Food intake side effects and nutrient absorption

• Medications + (causes) Unhealthy side effectscertain foods or therapies


Slide 9

How Can Diet Help with Medications?How Can Diet Help with Medications?

• Management of side effects

• Enhance flavour of foods

• Balanced meals help prevent side effects and promote adherence

• Avoid alcohol use with medications

• Address food security issues with client


Slide 10

Pregnant and Lactating WomenPregnant and Lactating Women

• More food needed during pregnancy and lactation

• Good nutrition status increases effectiveness of HAART/medications and reduces infant low birth weight


Slide 11

Infants and Children on HAARTInfants and Children on HAART

• Increased nutrition/energy needs

• Greater risk for malnutrition, morbidity (illness) and mortality (death)

• Closely monitor growth (weight and height), clinical signs of malnutrition (i.e. wasting, oedema) and feeding patterns


Slide 12

Common Side Effects from MedicinesCommon Side Effects from Medicines

• Nausea, vomiting, diarrhoea

• Poor appetite

• Changes in taste

• Metabolic Changes

• Iron Deficiency Anaemia

• Liver toxicity

• Rash/skin problems


Slide 13

Metabolic ChangesMetabolic Changes

• Lipodystrophy: changes in the way the body makes, uses and stores fat. Two types:• Lipoatrophy: loss of subcutaneous fat (fat under the

skin), mostly in arms, legs, buttocks, and face• Lipohypertrophy: fat accumulation, mostly around the

abdomen, chest, and behind the neck

• Biochemical changes: high blood fat levels, high blood sugar levels• Increases risk of heart disease and diabetes


Slide 14

Metabolic ChangesMetabolic Changes

• Associated ARVs• d4T (stavudine)• Possibly other NRTIs• Protease inhibitors and

boosted PIs• Early prevention, detection,

and treatment are important! • Look for physical signs of

lipodystrophy/lipoatrophy• Biochemical monitoring C. Steinberg © ITECH, 2006


Slide 15“Buffalo hump” in HAART-treated patient

Dorsocervical Fat Pad Dorsocervical Fat Pad

Source: Dominic C. Chow, MD, University of Hawaii; Larry J. Day, MD, University of Michigan; Cecilia M. Shikuma, MD, University of Hawaii


Slide 16

Central Fat AccumulationCentral Fat Accumulation

Visceral fat accumulation, before ART

Visceral fat accumulation, four months after starting ART

Courtesy of Dr. Stefan Mauss


Slide 17

Dietary Considerations forDietary Considerations forMetabolic ChangesMetabolic Changes

• Reduce refined starches (e.g. maize, white bread, pastas, sugar)

• Increase fibre from whole grains (e.g. oats, mahangu, brown bread) and fresh fruits and vegetables

• Eat more “good fats” from foods like oils, avocado, and nuts and less “bad fats” from butter and deep fried foods

• Exercise at least 45 minutes a day


Slide 18

Counselling Pre-HAARTCounselling Pre-HAART

• What are client’s eating habits?• Number of meals per day?• What are common foods eaten?• Any times when food is not available?• Any recent weight loss? How much?• Any current medications (consider modern and

traditional medicines)?• What are specific food-medication interactions or

common side effects of proposed ART regimen?


Slide 19

Counselling During HAARTCounselling During HAART

• What is the client’s food-HAART schedule?• What side effects does the client have?• Has the client lost weight since beginning

HAART?• Is the client taking other medications or

traditional therapies?• If traditional therapies taken: in what form (pill),

what is cost, and do these replace meals?


Slide 20

Weight Gain on Effective HAART Weight Gain on Effective HAART and Nutrition Therapyand Nutrition Therapy

Photograph by: David Walton Copyright 2003 Partners In Health

Before HAART After 1 year on HAART


Slide 21

Common HAART RegimensCommon HAART Regimens

• AZT/3TC/NVP (zidovudine – lamivudine – nevirapine)

• AZT/3TC/EFV (zidovudine – lamivudine – efavirenz)

• AZT/ddI/INV+r (zidovudine – didanosine – indinavir+ritonavir)

• AZT/ddI/LPV+r (zidovudine – didanosine – kaletra)


Slide 22

Sample Adult HAART Schedule Sample Adult HAART Schedule with Meal Planwith Meal PlanTime of Day Food Medication


Slide 23

Food and Medication Table ActivityFood and Medication Table Activity

• Questions to answer:1. Is the diet adequate for the medication

regimen this person is taking?

2. What should be changed, if anything?

3. What are some side effects with the medications?

4. What can you tell the client to do to prevent or manage potential side effects?


Slide 24

Case StudiesCase Studies


Slide 25

Key PointsKey Points

1. All persons need to have access to healthy food, especially those on HIV medications

2. Counsel clients on food effects of their medications

3. Help clients make a food-medication timetable

4. HIV medications can help a person with HIV live longer, but not without proper nutrition

session 3: nutrition and hiv medications nutrition management with hiv and aids: practical tools for...

Documents

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aids training slide

importance of nutrition

nutrition important

food effects of medications

progress of hiv disease

excretion medications

individual medications