Manual of Clinical Nutrition

HIV Infection and AIDS

Manual of Clinical Nutrition Management III- 49 Copyright © 2013 Compass Group, Inc.

bioimpedance spectroscopy, skinfold thickness measurements, and dual energy x-ray absorptiometry (Grade II)

(1,21). Further research is needed to determine the optimal methodology for body composition measurement in

women, children, different ethnic groups, and patients with lipodystrophy (Grade II) (1,21). Results of bioelectrical

impedance analysis may vary with the prediction equation used and the equipment manufacturer (1). Skinfold

thickness measurements may also vary with the number of sites measured and the prediction equation used (1).

Refer to Table III-10.

Table III-10: Evaluation Criteria for Weight and Body Composition Changes in HIV and AIDS (9)

Anthropometric

Measure

Criteria for Evaluation

BMI Normal BMI is 18.5 to 24.9 kg/m^2

<18.5 kg/m^2 suggests high risk for morbidity, mortality, and the development or

presence of wasting or lipoatrophy

>24.5 kg/m^2 suggests potential for obesity-related diseases and central fat

accumulation

BCM Ideal BCM is 100%

<95% suggests wasting and associated complications of reduced body functions

related to muscle degeneration and mass (eg, ability to sit, swallow, and breathe)

and reflects changes in hormonal stasis

<55% is associated with the timing of death (9,20)

Weight Change >5% unintentional weight loss is associated with increased risk of morbidity and

mortality

>5% unintentional weight gain is associated with increased risk for central fat

accumulation

Adapted with permission from the Academy of Nutrition and Dietetics from: Nutrition-focused physical findings in HIV/AIDS. In: Nutrition
Care Manual. Academy of Nutrition and Dietetics; Updated annually. Available at: http://www.nutritioncaremanual.org. Accessed November 15,
2010.

Energy requirements: The resting energy expenditure (REE) is increased with HIV infection, and this increase

may contribute to weight loss. Numerous studies have found that HIV-infected adults have greater REE as

compared to healthy controls (1,21,35). However, the total energy expenditure was similar to that of control

subjects (Grade II) (1,21). Higher REE has been correlated with fat-free mass, but it has not been consistently

correlated with weight or disease status.” (1,21,36). Factors related to energy needs in people with HIV infection

include stage of disease, opportunistic infections and co-morbidities, inflammation, and effects of medications

(Grade II) (1,21). Alterations in endocrine function and reduction of energy intake are associated with wasting (37).

The impact of ARTs on energy requirements is related to the patient’s response to treatment. Successful

treatment with ART decreases REE and promotes weight gain, whereas a lack of response to treatment is

associated with wasting (1,38,39). Further research is needed to determine the exact energy requirements of

patients with HIV or AIDS (Grade II) (1,21). The REE can be estimated by using predictive formulas and considering

additional energy needs associated with fever, infection, diarrhea or malabsorption, weight loss or loss of BCM,

and physical activity (1,9). The energy requirements of patients who receive ART and patients who have

lipodystrophy, glucose intolerance, or obesity may need to be decreased (1,9). (Refer to Section II: “Estimation of

Energy Expenditures”.)

Protein requirements: Protein is essential for the maintenance of BCM and normal body functions, including

immunity (1,40). Although increased protein intake may have beneficial effects (eg, the maintenance of BCM) for

individuals with HIV; the specific protein requirements, protein turnover, and the effects of increased protein

intake in persons with HIV have not been adequately studied (Grade III) (1,21). Protein requirements should be based

on the disease stage, BCM, nitrogen balance studies, and physical activity level (1,9). Coexisting complications to

HIV or AIDS should also be considered; these complications include malabsorption, infection, wasting syndrome,

impaired renal function, and impaired hepatic function.

Fat requirements: High-fat, low-fiber diets are fairly common in both the general population and in HIV-

infected persons (1). Studies have found that HIV-infected people generally consume diets that are high in total

fat, saturated fat, and cholesterol (Grade II) (1,21). Evidence supports a relationship between diets that are high in

saturated fat and total fat and hyperlipidemia, particularly hypertriglyceridemia (1). Studies indicate that diets

that are low in saturated fat and total fat and that include omega-3 fatty acids result in reduced triglyceride levels,

increased high-density lipoprotein cholesterol levels, and lower risk of lipodystrophy (Grade II) (1,21,25). Although the