times by the U.S. Department of Health and Human
Services. The following is the most recent set of stand-
ards, issued in October 2005:
All patients with history of an AIDS-defining illness
or severe symptoms of HIV infection should receive
antiretroviral therapy regardless of CD4þT cell
count.
Antiretroviral treatment is recommended for asymp-
tomatic patients with less than 200 CD4þTcells/mL.
Asymptomatic patients with CD4þT cell counts of
201—350 cells/mL should be offered antiretroviral
treatment.
For asymptomatic patients with CD4þT cell of
greater than 350 cells/mL and plasma HIV RNA
greater than 100,000 copies/ml, most experienced
clinicians defer therapy but some clinicians may con-
sider initiating antiretroviral treatment.
Antiretroviral therapy should be deferred for patients
with CD4þT cell counts of greater than 350 cells/mL
and plasma HIV RNA less than 100,000 copies/ml.
It is this set of guidelines for HAART that nutri-
tionists currently work with when planning healthful
diets for patients with HIV infection and AIDS.
Description
While there is no standard ‘‘HIV diet’’ or ‘‘AIDS
diet’’ because patients’ symptoms, medication regi-
mens, and corresponding nutritional needs vary so
widely, there are general practices followed by regis-
tered dietitians who work with doctors and other
health care professionals to care for these patients.
Dietetics consultation and follow-up
Patients with HIV infection should consult a reg-
istered dietitian (RD) as soon as possible after diag-
nosis, because good nutrition is essential to maintaining
a normal level of activity and self-care as well as sup-
porting the patient’s immune system. RDs use several
screening questionnaires to evaluate patients for poten-
tial nutritional problems. On the patient’s first visit, he
or she is given a quick nutrition screen or QNS to fill
out. A sample QNS from a California medical center
may be found online at http://www.rwca2006.com/
presentation/workshop/Tuesday_08.29.06/Workshop
_C/432_Quick%20Screen.pdf. The QNS identifies such
problems as unintentional weight loss, nausea, diffi-
culty swallowing, and diarrhea. The dietitian then
measures the patient’s height, weight, skinfold thick-
ness, and the circumference of the muscles on the
patient’s midarm. These last two measurements are
needed in order to monitor changes in body fat distri-
bution and muscle wasting that often accompany HIV
infection.
The next step in the initial assessment the patient’s
completion of a food intake record (FIR). The patient
is asked to record everything he or she eats or drinks in
a 24-hour period, including snacks and alcoholic bev-
erages. If possible, the patient will fill out two FIRs,
one for a working day and one for a weekend day or
holiday. The FIR allows the dietitian to evaluate the
patient’s usual eating habits, portion sizes, food pref-
erences, and average calorie intake. It also establishes
a baseline for the individual patient, so that loss of
appetite later on or other nutritional problems can be
detected as quickly as possible.
Follow-up visits to the dietitian are scheduled
according to the degree of the patient’s nutritional
risk. The American Dietetic Association and the Los
Angeles County Commission on HIV Health Services
use the following timelines for HIV patients at nutri-
tional risk:
Low risk: The patient’s weight is stable, with a bal-
anced and adequate food intake; normal blood levels
of cholesterol, triglycerides, and glucose; no evidence
of kidney or liver disorders; regular physical exercise;
and low levels of psychosocial stress. Low-risk
patients are evaluated by the RD as needed, but at
least once a year.
Moderate risk: The patient is obese or suffers from
changing patterns of body fat distribution; has high
blood cholesterol levels or high blood pressure; has
developed an eating disorder, nausea, vomiting, or
diarrhea; has been recently diagnosed with type 2
diabetes or food allergies; is in recovery from sub-
stance abuse; or is under psychosocial stress. Mod-
erate-risk patients should be seen by the RD within a
month.
High risk: The patient is pregnant; suffers from poorly
controlled diabetes; has lost 10% of body weight over
the previous 4–6 months; has lost 5% of body weight
in the previous 4 weeks; has dental problems, involve-
ment of the central nervous system, severe nausea or
vomiting, severe pain on swallowing, or chronic diar-
rhea; has one or more opportunistic infections; or
is under severe psychosocial stress. These patients
should be seen by an RD within one week.
In addition to assessment of the patient’s nutri-
tional needs, RDs also evaluate his or her living situa-
tion and other issues that may affect receiving adequate
nutrition.AIDS/HIV infection