HIV Infection and AIDSManual of Clinical Nutrition Management III- 51 Copyright © 2013 Compass Group, Inc.
include ginseng, melatonin, milk thistle, geniposide, and skullcap (44). Unless carefully tested for safety and
medication interactions in persons with HIV or AIDS, herbal supplementation should not be recommended in this
population (1,9). (Refer to Table III- 11 : HIV Medications: Names, Forms, Interactions, and Potential Side Effects
(9).)
Physical activity recommendations: Exercise has been recommended as a strategy to maintain body function,
restore and maintain adequate nutritional status, and assist in the management of altered glucose, lipid, and bone
mineral metabolism (1). A review of evidence found that 20 or more minutes of constant or interval aerobic
exercise, progressive resistant exercise, or a combination of both at a frequency of three times per week
appeared to be safe in adults with HIV infection and may lead to significant improvements in cardiopulmonary
fitness and a reduction in depressive symptoms (Grade I) (1,21). The impact of physical activity on immune status
remains unclear (1). Special considerations should be given to patients with HIV who have active infection,
reduced aerobic capacity, metabolic changes, or increased pain, fatigue, or impairment while exercising (1).
Further research is needed on the effects of exercise on the serum lipid profiles of persons with HIV infection
(Grade I) (1,21).
HIV and AIDS in children and adolescents: Children with HIV experience the same nutritional issues as
adults who have the disease, but because of the added demands of growth and development, the effects in
children are often more devastating (1). Early nutrition intervention is very important, and routine nutrition
assessment should include monitoring of height, weight, and head circumference with comparison to growth
standards for age and sex (1). Additional serial measures for anthropometry may include thigh circumference
and mid-upper arm circumference (1). Deleterious nutritional outcomes commonly experienced by children
with HIV or AIDS include the inability to achieve a normal weight for height, growth stunting, failure to thrive,
malnutrition, impaired cognitive development or developmental and oral-motor feeding skill delay due to
HIV encephalopathy, and wasting (1). Children infected with HIV are considered at high nutritional risk and
should be referred for ongoing nutrition assessment and counseling (1).
Medications
There have been many advances in the pharmacologic treatment of HIV infection (1,9). The advent of HAARTs
and combination medication therapies has reduced viral loads and increased the quality and length of life in
patients with HIV or AIDS (1,10). Treatment of HIV infection with combination ART has been associated with
improved nutritional indicators, such as BMI and BCM, as well as negative consequences such as detrimental
toxicities and compromised bone mineral density affecting nutritional status (1,45-47). The benefits of ARTs
(eg, maintaining BMI and BCM) must be evaluated against the potential for negative health outcomes. The
registered dietitian must consider the adverse influences of various medications on indicators of nutrition
status and metabolic indicators of disease risk (1). The clinician must recognize that nutrients and nutritional
status can affect medication absorption, utilization, elimination, and tolerance (1,48). Potential nutrition-
related adverse effects that are related to ART include dyslipidemia, insulin resistance and glucose
intolerance, and anemias (1,22,23). (Refer to the discussion of Lipodystrophy and Metabolic Disease in HIV and
AIDS earlier in this section.) Patient adherence to prescribed medication regimens is needed to optimize
treatment outcomes and should be assessed (1). Patient adherence to the prescribed medication regimen is
affected by negative side effects, changes in body composition (eg, body fat changes as seen in lipodystrophy),
and body image issues (1). (Refer to Table III- 11 : HIV Medications: Names, Forms, Interactions, and Potential
Side Effects (9).)
There are currently six classes of antiretroviral medications (1,9):
Nucleoside reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
Entry inhibitors
Integrase inhibitors
There are also dual-class, fixed-dose, combination drugs that allow for fewer pills or once daily doses (1).
Emerging drugs under investigation include a class of maturation inhibitors and other medications that boost
the levels of antiretroviral medications (1). Most HIV-infected patients will require life-long pharmacotherapy
for disease management (1). Response to ART can vary according to sex, and men and women with HIV
infection may experience problems associated with medication interactions differently (1). For example, as