Nicole Karetov
Case Study #3: AIDS
6. What are the common nutritional complications of HIV and AIDS?
HIV/AIDS is highly impacted by nutritional status. It is important for an HIV positive individual to achieve adequate nutrition for disease management and for improved clinical outcomes. Weight loss may occur with HIV disease as a result of a lifelong inflammatory process. AIDS-related wasting syndrome may eventually occur in which an individual unintentionally loses 10% of their body weight with fever or diarrhea for more than one month.
In addition, factors such as suppression of the immune system, side effects of HIV medications and opportunistic infections could cause a variety of other nutritional problems. These problems include increased energy expenditure, inadequate oral food/beverage intake, excessive bioactive substances, increased nutritional needs, malnutrition, inadequate protein-energy intake, difficulty swallowing, altered GI function, impaired nutrient utilization, altered nutrition-related lab values, food-medication interactions, underweight, impaired ability to prepare food/meals, physical inactivity and intake of unsafe food.
7. Are there specific recommendations for energy, protein, vitamin and mineral intakes for someone with AIDS?
Nutrition recommendations are highly individualized between patients. Fluid maintenance is important due to fluid losses in diarrhea or sweating and to prevent dehydration. Calorie needs depends on the individual, and it is essential to maintain calorie intake to maintain a healthy weight. Calories may be increased depending on if the patient desires to gain weight, or if there is an increase in metabolic rate due to an opportunistic condition. In addition, calories may be decreased to achieve weight loss. Generally, 25 kcal/kg is recommended for weight loss, 30 kcal/kg for maintenance and 35-40 kcal/kg for weight gain. Protein intake is dependent on need for protein stores maintenance. In HIV infection, protein turnover rates are elevated due to the breakdown of labile protein stores in muscle to enhance the amino acid pool and maintain immune and healing responses. Increased protein intake is recommended for someone with HIV/AIDS (1.0-1.4 g/kg for maintenance and 1.5-2.0 g/kg for repletion).
A decrease in micronutrients is associated with an increase in disease progression and morbidity. Supplementation of vitamins and minerals is recommended. Anemias, diarrhea, and potential dietary deficiencies can be treated with micronutrients. Some important micronutrients in HIV infection include Vitamin A, riboflavin, Vitamin B12, ascorbic acid, iron, selenium and zinc.
8. Evaluate the patients anthropometric information
a. Calculate % UBW and BMI
% UBW = 151 lbs/ 160-165 lbs x 100 = 94.4-91.5%
BMI = 68.6 kg/1.854 m² = 19.95 = 20
b. Compare the TSF to population standards. What does this comparison mean? Is this a viable comparison? Explain
The patient's TSF is 7mm, meaning he is between the 15th to 20th percentile for his age group. A normal TSF range is 11-12.5mm, meaning the patient is well below a normal reading. This is not a viable comparison for Mr. Long. Lipodystrophy can occur in HIV positive individuals, so additional skin fold measurements throughout the body should be taken to note fat patterning and changes in fat distribution.
c. Using MAC and TSF, calculate upper muscle area. What can you infer from this calculation?
AMA = [MAC (cm)- (3.14 x TSF in cm)]² – 10/(4 x 3.14)
[25.4 – (3.14 x .07)]²
– 10 / (4 x 3.14) = 40.48 mm²
According to this calculation, Mr. Long has marginal muscle mass and is at 75% of the standard. He is not yet at depleted or wasted muscle mass.
d. Mr. Long's body fat percentage is 12.5%. What does this mean? Compare this to the standards
A normal range for men aged 20-40 years is 8-19% body fat. This means Mr. Long's body fat is within a normal range at 12.5%.
9. Determine Mr. Long's energy and protein requirements.
Harris Benedict Equation =
REE = 66.5 + (13.8 x 68.6 kg) + (5.0 x 185.4 cm) – (6.8 x 32 yrs) = 1723 kcal
TEE = 1723 kcal x 1.2 = 2066 kcal/day
or 35-40 kcal x 68.6 kg = 2401 – 2744 kcal for weight gain
Protein = 1.5-2.0 g/68.6 kg = 103 – 137 g/day
13. Using this patient's lab values, identify those labs used to monitor his disease status. What do these specifically measure, and how would you interpret them for him? Explain how the virus affects these lab values.
T-helper cell, T-suppressor cell count and HIV-1 RNA Quant are used to monitor the patient's disease status. HIV causes a decrease in CD4 count (T-helper cells) due to cell damage and alterations. A reduction of CD4+ cells to ................
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