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Nutrition support and the human immunodeficiency virus (HIV)

Published online by Cambridge University Press:  06 April 2009

S. J. Bell ,
E. A. Mascioli ,
R. A. Forse  and
B. R. Bistrian
S. J. Bell*
Affiliation:
Surgical Metabolism Laboratory, 194 Pilgrim Road, Deaconess Hospital, Boston, MA 02215, USA
E. A. Mascioli
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
R. A. Forse
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
B. R. Bistrian
Affiliation:
Harvard Medical School, Department of Medicine, Deaconess Hospital, Boston, MA, USA
*
*Corresponding author.
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Summary

Nutritional support of patients with HIV or acquired immune deficiency syndrome (AIDS) has many similarities to other disease states in that the same nutritional products and techniques are used. Some patients with HIV, and many with AIDS without secondary infection, experience a metabolic milieu similar to patients with cancer cachexia. In providing dietary counselling to the HIV patient, we encounter many of the obstacles that must be overcome to improve nutrition in cancer: anorexia, gastrointestinal discomfort, lethargy, and poor nutrient utilization, which limit the ability for nutritional repletion. When a secondary infection is superimposed on HIV, patients resemble more highly catabolic trauma patients or patients in the intensive care unit (ICU), where, despite aggressive efforts to feed, there is usually a net nitrogen wasting leading to the more rapid development of cachexia. However, even in this setting, feeding will limit substantially net catabolism when compared to total starvation. Because the nutritional needs of HIV patients vary greatly, individual strategies have to be designed as the patient moves through the stages of disease. Patients are generally able to consume adequate nutrition either as regular food or dietary supplements during the latency period of viral replication. Once secondary infections become prevalent, artificial diets administered by tube or by vein may be required during the period of active secondary infections, with dietary supplements often helpful during more quiescent periods. Patients with HIV are among the most challenging for clinicians providing nutritional support. Knowledge from treatment of patients with other diseases may be useful, but more data must be gathered on the unique aspects of aetiology and treatment of the anorexia, malabsorption, and ultimate wasting associated with AIDS.

Keywords

nutrition supportAIDSmalnutrituion
Type
Research Article
Information
Parasitology , Volume 107 , supplement S1: Human nutrition and parasitic infection , January 1993 , pp. S53 - S67
Copyright
Copyright © Cambridge University Press 1993

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