Manual of Clinical Nutrition

HIV Infection and AIDS

Manual of Clinical Nutrition Management III- 57 Copyright © 2013 Compass Group, Inc.

Complication Possible Causes Nutrition Interventions

Early satiety Medication

Infection

Nausea

Review medications.

Recommend, small, frequent feedings;

nutrient-dense foods; liquids between

meals; and avoidance of greasy, fried foods

and gas-forming foods.

Consider medical nutritional supplements as

between-meals snacks.

Consider vitamin and mineral supplements if

symptoms or biochemical tests indicate

deficiency.

Food intolerances Medication

Infection

Gastrointestinal disturbance

Poor dentition

Genetic cause

Review medications.

Recommend alternative foods and textures;

evaluate patient for nutrient deficiencies.

Consider medical nutritional supplements as

tolerated.

Consider vitamin and mineral supplements if

symptoms or biochemical tests indicate

deficiency.

Taste and smell changes Medication Investigate and treat cause.

Change, initiate, or discontinue medication.

Recommend small, frequent feedings;

experiment with a wide variety of foods

and seasonings and alternative protein

sources.

Nutrition prescription: The registered dietitian should determine the appropriate mode of nutrition support
based on the nutrition assessment and diagnosis. A combination of approaches may be necessary to address the
nutrition-related problems faced by persons with HIV (1). Meal planning using guidelines established for lipid
management and diabetes management may also be necessary in patients who develop lipodystrophy or glucose
intolerance related to medication management (1,9). For these patients refer to Section C: “Modification of
Carbohydrate and Fat”. Consider the following information when determining the nutrition prescription:
 Oral feedings are preferred over any other feeding method. Efforts to maintain the oral feeding route
should be maximized. Nutrient-dense foods and supplements should be used to support maintenance
and restoration of nutritional status and body weight. Appetite stimulants may be indicated for patients
who experience anorexia (1,9).
 The enteral feeding route is preferred over parenteral administration in order to preserve gut structure
and function. Assess patients carefully and reassess them on a regular basis. Patients with AIDS-related
wasting syndrome should be carefully monitored for refeeding syndrome (1,9). (See Section B:
“Specialized Nutrition Support”.)
 Parenteral nutrition may become necessary when a patient meets the criteria for initiation of total
parenteral nutrition (9). Continual assessment and routine monitoring of laboratory values is essential.
Patients with AIDS-related wasting syndrome should be carefully monitored for refeeding syndrome (9).
(See Section B: “Specialized Nutrition Support”.)

Pediatric-specific interventions: The goals of intervention for children with HIV infection are similar to the
goals for adults with the added dimension of supporting adequate growth and development (1). Mothers with HIV
should be made aware of the risks and benefits of different infant-feeding options, including the risk of HIV
transmission through breastfeeding (1). The World Health Organization has issued recommendations for infant
feeding (52). The World Health Organization recommends the continued use of prophylactic antiretrovirals for
mothers and children to reduce the risk of HIV transmission through breast milk (52).

Patient education and food safety: Education and counseling are essential features of medical nutrition therapy
for people infected with HIV (1). Patients infected with HIV have weakened immune systems and are more
susceptible to contracting foodborne illnesses, as shown by a recent review by the Academy of Nutrition and