CASE STUDY: AIDS WITH OPPORTUNISTIC INFECTION



HIV/AIDS Case Study

Name: Dawn Ortiz

MR is a 38-year-old man who presented to the outpatient clinic with weight loss. He was in his usual state of health until 3 years ago, when he presented to an AIDS Service Organization (ASO) for an HIV test, shortly after his brother died of AIDS. When the results came back positive, he was provided with a list of physicians and clinics for follow-up care. However, he stated that he felt well at that time and remained without complaints until 6 months before this presentation.

MR works in the construction industry as a finish carpenter. His daily activities were becoming increasingly limited by the several bouts of watery diarrhea, which was associated with nausea. MR compensated by reducing his food intake. After several days of decreased intake, his diarrhea would decrease, but he became weak and ultimately lost his appetite. His job was threatened by frequent absenteeism because of weakness and diarrhea.

MR noted additional weight loss and loose-fitting clothes. He denied fever, chills, night sweats, or muscle or joint pain.

Usual Dietary Intake

Food Intake: Primarily crackers, rehydrating sports drinks and juices.

Approximately 500 calories/day over the past 2 weeks.

Alcohol Intake: none recently

Tobacco: None

IV drug use: None

Body Composition Data

Parameter Patient’s Values Normal Value

Fat-free mass (lbs) 105.7 >102.3

Body cell mass (lbs) 48.1 >55.4

Extracellular tissue (lbs) 54.1 47-53

Fat (lbs) 15 12-24

Mid-upper arm circumference 27.5 (5th%) 30-5-34.2 (25-75th%)

Triceps fatfold (%) 4 mm (500,000 copies/mL

CD4 count: 50 cells/mm³

Albumin: 3.4 g/dL

Hgb: 10.0 g/dL

Hct: 31%

ALT: 22 U/L

AST: 22 U/L

Alkaline Phosphatase: 160 IU/L

Total cholesterol: 85 mg/dL

LDL cholesterol: 60 mg/dL

HDL cholesterol: 20 mg/dL

Triglycerides: 300 mg/dL

Glucose: 120 mg/dL

Testosterone: 300 ng/dL

Case Questions:

1. Compare MR’s weight and body composition to appropriate goal levels. What do the results suggest for his level of wasting and medical problems?

MR qualifies as an AIDS patient, because he has lost 28#, 20% weight loss with diarrhea in 6 weeks. MR’s cell mass compartment has been depleted by 16#, which is 15% under ideal (a 5% loss of body cell mass falls under the definition of wasting). Although MR’s fat free mass is adequate, his fat weight, upper arm circumference and tricep fatfold are below normal. MR’s poor food intake and excessive diarrhea may set his body into a state of starvation. His elevated electrolyte labs indicate infection, however his body may be too weak to produce the normal inflammatory response.

2. What factors may have contributed to MR’s wasting?

MR’s wasting can be attributed to the excessive diarrhea he is experiencing, resulting in fluid loss and nutrient malabsorption. MR’s low testosterone level may also be a cause of his body cell mass loss. The HIV viral load and low CD4 count increases risk for infection and contributes to weight loss.

3. What is your overall impression of MR’s nutritional status? Calculate MR’s calorie and protein needs (show your calculations).

MR is malnourished and symptomatic. His low albumin and cholesterol with anemia are indicative of advanced HIV. Adequate nutrition therapy is necessary for his body to support anti-HIV medications. The MNT goal should be to restore his body weight back to his UBW of 145#. However, MR is at risk for refeeding syndrome since his appetite and intake has been extremely low for the past 6 weeks. He should start with a low residue diet consisting of small frequent meals, consuming 50% of his resting energy expenditure.

Harris-Benedict Equations (calories/day):

Male: (66.5 + 13.8 X 53) + (5.0 X 173) - (6.8 X 38)

=798 + 865 – 258

= 1405 x .50

=703 kcal to start

Kcal should be advanced slowly by 10% as tolerated, until a goal of 35-40 kcal/kg (1855-2120 kcal/day)

Protein should be 1.5-2 g/kg/day, 80 g/day. (80 – 106 g)

4. Define HIV and list the stages of HIV infection.

HIV: Acronym for the Human Immunodeficiency Virus, the cause of AIDS (acquired immunodeficiency syndrome), is an incurable, retrovirus affecting the immune system.

Stages of HIV:

1. Acute HIV infection—Virus replicates, CD4+ cell counts are increased to help fight virus.

2. Clinical latency—Virus continues to replicate, CD4+ cell counts decrease because virus has taken over, no symptoms.

3. Symptomatic HIV infection—CD4+ cell counts lower, symptoms are present; fever, diarrhea, weight loss and muscle wasting.

4. Progression to AIDS—Extremely low CD4+ cell count (below 200 ml cubed), AIDS defining condition, viral and bacterial infections, and cancers present.

5. What are the primary routes of HIV transmission?

HIV is transmitted by blood (IV drug use, transfusions), sexually (semen, vaginal fluid), breast feeding or amniotic fluid.

6. What criteria must be met to progress from HIV to AIDS?

CD4 lymphocyte < 200 cells/mm3 (or CD4 lymphocyte ................
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