HIV Infection and AIDSManual of Clinical Nutrition Management III- 47 Copyright © 2013 Compass Group, Inc.
progression of disease, decrease the disease severity, and improve longevity (1). The treatment and
management of HIV with ARTs present many nutritional challenges as the antiretroviral medications can alter
body composition and metabolic pathways (1,9). Common nutrition diagnosis and nutrient deficiencies that
occur in HIV and AIDS include protein-energy malnutrition, various forms of anemia, and alterations in
nutrients such as zinc, iron, selenium, vitamin B 12 , carbohydrate, and fat (1,15-17). Nutrition is paramount in
supporting the health and quality of life of HIV-infected persons (1). The registered dietitian should complete
routine comprehensive nutrition assessments to identify nutrition alterations and manage the diverse
complications associated with HIV or AIDS and its treatments (1). The most common nutrition complications
experienced by persons with HIV or AIDS are comprehensively discussed here.
Weight, Body Composition, and AIDS-related Wasting Syndrome
One of the leading nutrition indicators correlating with survival in HIV is weight status (1). Body mass index
(BMI) and adequate body cell mass (BCM) are reliable indicators used to determine acute changes in weight
and lean tissue in persons with HIV infection or AIDS (1,9,18). The HIV infection leads to an inflammatory
response and challenges to the maintenance of weight and lean tissue stores (9). Even small losses of lean
tissue are associated with an increase in morbidity and mortality for HIV-infected persons (9,10,19). With a loss
of BCM to a level of 54% of the expected value based on height, death is likely to occur in patients with HIV
infection regardless of the presence or absence of infectious complications (20). A major component of the
clinical syndrome in HIV infection and AIDS is AIDS-related wasting syndrome (6).
The CDC defines AIDS-related wasting syndrome as an involuntary weight loss of greater than 10% of
baseline body weight accompanied by one of the following criteria (6):
chronic diarrhea (at least two diarrheal stools per day for 30 days or longer), or
chronic weakness and documented fever for 30 days or longer in the absence of a concurrent illness or
condition other than HIV infection that could explain the findings
Although the number of AIDS cases has dramatically decreased since the introduction of ARTs, the wasting
syndrome continues to occur in approximately 20% of AIDS cases in the United States (9,10). More recent
information suggests that weight loss or wasting syndrome occurs in more than 30% of HIV-infected patients
regardless of anti-HIV treatment with a total prevalence rate of nearly 40% in the infected population (9,10). The
causes of wasting syndrome and malnutrition in HIV disease are complex and multi-factorial (1,9). Suspected
mechanisms of weight and protein losses include compromised food intake caused by anorexia and increased
utilization of nutrients associated with inflammatory responses (1). Other causes may include reduced intestinal
absorption, which can affect the absorption of carbohydrate and fat, resulting in lactose and fat malabsorption.
Diarrhea, a symptom of malabsorption, is associated with the AIDS-related wasting syndrome (6). Diarrhea and
malabsorption can lead to nutrient deficiencies and compromised energy intake that adversely affect weight
status, immune functions, and other normal body processes (1). Further research to support dietary treatment of
diarrhea and malabsorption in HIV and AIDS is needed (Grade II)* (1,21). Research on effective treatments, such as
amino acid–based elemental diets, probiotics, pancreatic enzyme therapy, calcium carbonate, glutamine, and the
BRAT diet (bananas, rice, applesauce, and toast), as well as the effects of medications is warranted based on a
review of current evidence (Grade II) (1,21). For people with HIV infection who have diarrhea/malabsorption, the
registered dietitian (RD) should encourage the consumption of soluble fiber, electrolyte-repleting beverages
and medium-chain triglycerides (MCT) and decrease the consumption of foods that may exacerbate diarrhea
(Grade II) (21). Studies of fat malabsorption reported that consumption of MCT resulted in fewer stools,
decreased stool fat and weight and increased fat absorption (Grade II) (21). Both unintentional weight loss and
lean tissue loss require strategies to ensure that adequate macronutrients are consumed, absorbed, and
assimilated to prevent and reverse weight loss and wasting syndrome (1). Considering the critical importance of
weight and maintenance of lean body stores, the routine monitoring of body composition by using
anthropometric and other measures is recommended in determining nutritional risk and applying appropriate
nutrition interventions (Grade I) (1,21).
Lipodystrophy and Metabolic Disease in HIV and AIDS
With the development of new combinations of medications referred to as ARTs, people with HIV or AIDS are
living longer (1-5,9). These medication regimens, however, create nutritional challenges including
dyslipidemia, insulin resistance and glucose intolerance, and various types of anemias (1,22,23). Lipodystrophy,
the abnormal metabolism and deposition of fat, is a common side effect of ARTs (1). Lipodystrophy includes
lipoatrophy, which is the loss of subcutaneous fat, and lipohypertrophy, which is the gain of truncal fat (24).
The lipodystrophy-associated alterations in body composition have metabolic consequences that lead to
dyslipidemia and insulin resistance (1,24). A higher prevalence of risk factors for cardiovascular disease