health risks in HIV patients

Malnutrition is common in HIV patients due to the compromised immunity and resulting poor appetite (anorexia). Also, oral/gastrointestinal symptoms such as pain, nausea, vomiting, malabsorption , and diarrhea may arise from HIV infection, secondary infections, encephalopathy or drug therapies.

Inability to eat food secondary to complicated medical regimens or fatigue adds to the nutritional risk. these patients are prone to infections usually termed as opportunistic infections.

All of these symptoms may prevent adequate nutritional intake , resulting in continued weight and lean tissue loss , vitamin or mineral deficiencies , and poor nutritional status.

It is important to assess the degree of malnutrition or the extent of health risks:

The priority timeline for referral for patients categorized by nutritional risk is as follows:

(1) high risk, to be seen by an Registered Dietitian within 1 week;

(2) moderate risk, to be seen by an Registered Dietitian within 1 month; and

(3) low risk, to be seen by an Registered Dietitian as needed.

 

Below is the detailed description of above mentioned categories:

High risk

  1. Poorly controlled diabetes mellitus.
  2. Pregnancy (mother’s nutrition; infant: artificial infant formula).
  3. Poor growth, lack of weight gain, or failure to thrive in pediatric patients.
  4. >10% unintentional weight loss over 4–6 months.
  5. >5% unintentional weight loss within 4 weeks or in conjunction with
  6. Chronic oral [or esophageal] thrush.
  7. Dental problems.
  8. Dysphagia.
  9. Chronic nausea or vomiting.
  10. Chronic diarrhea.
  11. CNS disease.
  12. Intercurrent illness or active opportunistic infection.
  13. Severe dysphagia.
  14. Enteral or parenteral feedings.
  15. Two or more medical comorbidities, or dialysis.
  16. Complicated food-drug-nutrient interactions.
  17. Severely dysfunctional psychosocial situation (especially in children).

Moderate risk 

  1. Obesity.
  2. Evidence for body fat redistribution.
  3. Elevated cholesterol (>200 mg/dL) or triglycerides (>250 mg/dL), or cholesterol <100mg/dL.
  4. Osteoporosis.
  5. Diabetes mellitus, controlled or new diagnosis.
  6. Hypertension.
  7. Evidence for hypervitaminoses or excessive supplement intake.
  8. Inappropriate use of diet pills, laxatives, or other over-the-counter medications.
  9. Substance abuse in the recovery phase.
  10. Possible food-drug-nutrient interactions.
  11. Food allergies and intolerance.
  12. Single medical comorbidity.
  13. Oral thrush.
  14. Dental problems.
  15. Chronic nausea or vomiting.
  16. Chronic diarrhea.
  17. CNS disease resulting in a decrease in functional capacity.
  18. Chronic pain other than oral/gastrointestinal tract source.
  19. Eating disorder.
  20. Evidence for sedentary lifestyle or excessive exercise regimen.
  21. Unstable psychosocial situation (especially in children).

Low risk

  1. Stable weight.
  2. Appropriate weight gain, growth, and weight-for-height in pediatric patients.
  3. Adequate and balanced diet.
  4. Normal levels of cholesterol, triglycerides, albumin, and glucose.
  5. Stable HIV disease (with no active intercurrent infections).
  6. Regular exercise regimen.
  7. Normal hepatic and renal function.
  8. Psychosocial issues stable (especially in children).

 

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