Delays the progression of HIV

Reduces the cost of medical care

Reduces complications and hospitalizations

Shortens the duration of hospital stays

Improves effectiveness and tolerance to medications and treatments

Increases productivity and independence

Increases the ability to remain at home
 

Proactive nutrition intervention can result in fewer complications, leading to a reduced cost of care and increased quality of life. To allow maximum benefit and cost effectiveness, nutritional intervention and education should start at the time of initial HIV-positive diagnosis and continue throughout the disease process.

A survey was conducted to determine the nutritional care guidelines of a representative sample of AIDS Service Organizations and nutritionists with extensive experience in the care of HIV-positive people. Literature searches on MEDLINE, AIDSLINE and the World Wide Web revealed six associations have announced nutritional care guidelines for individuals with HIV and AIDS. Seventeen additional organizations were polled to acquire information on their use of nutritional care guidelines. 

Among these 17, six employ nutritionists with extensive experience (> 5 years) in the care of HIV-positive people. Only two organizations did not share information on their nutritional care practices. Sixty percent (n=9) of the 15 organization's responding to the survey habitually practiced full or minimal nutritional care guidelines. Among these, only three followed written guidelines that had been officially approved. Two of the three follow the recently developed American Dietetic Association's HIV/AIDS Protocol. Five of the total number of nutritional care guidelines (n=15) recommend that HIV nutrition specialists be utilized.

The majority of nutritional care guidelines (n=13) suggest at least two visits per year for each client. Some people who experience more serious complications that affect nutritional status and weight are seen more often. Twenty percent (n=3) of the organizations recommend quarterly visits.

Clinical standards of care that include nutritional services are becoming the foundation for HIV disease management. HIV standards of care differ based on region, treatment philosophy and patient population.

1) delays the progression of HIV; 2) reduces complications and hospitalizations; 3) shortens the duration of hospital stays; 4) reduces the cost of medical care; 5) improves effectiveness and tolerance to medications and treatments; 6) increases productivity and independence; and 7) increases the ability to remain at home.

Considering all the risk factors that lead to poor nutritional status one can draw the conclusion that PLWHIV can benefit greatly from early and continuous nutritional care. HIV-savvy clinicians agree there is a dire need for nutritional care guidelines.

In Broward County Florida there were 3,700 cases of AIDS reported through March 31st 1997. It's interesting that (based on a Ryan White Title IIIB Mid-Year update) 94% of the HIV-positive people who entered the Broward County primary care system had CD4 T-cell counts between 200-500. Yet, according to a county-wide client survey only 499 HIV-positive people used nutritional services and 369 said they would seek out services in the next 12 months.  A total of 1,211 HIV-positive individuals completed the Ryan White Title I Needs Assessment. Ryan White Title I service utilization data shows that more than 3,600 people living with HIV received outpatient medical care for 1997-1998. Yet, less than 1/3 of these individuals received nutritional services. As the shift in health care finally attempts to focus on preventive care many of these individuals will seek out nutritional attention.

Additional information on Nutritional Care Guidelines is in Issue 9 of the  HIV ReSource Review

The purpose of this study was to document and evaluate variations in the weight status of individuals with HIV and AIDS. As decreased food intake is the most important factor in weight loss, data was collected on food bank clients at all stages of HIV disease. A total of 219 adults received nutritional services during the four month study period. Of those, 86 men and 40 women participated in nutritional assessments that included the documentation of weight status.

Weight status indicators were analyzed and percentages were calculated. Data analysis reveals that 63% (25) of the women and 72% (62) of the men weighed below their usual body weight (UBW). Forty percent of the women and 38% of the men weighed less than 90% of their UBW. Among those, the minimum of UBW was 64% for the women and 70% for the men. Men were more likely to weigh less than their desirable body weight for an HIV-negative status (DBW-). Thirty (35%) of the men and 8 (20%) of the women weighed less than 90% of their DBW-. Women were more likely to weigh above their desirable body weight for an HIV-positive status (DBW+). Only 19% of the men and 53% of the women weighed more than their DBW+. The highest percentage for DBW+ was 169% for the men and 215% for the women.

Study findings indicate that: 1) many HIV-positive people do experience weight loss; 2) in this group of individuals, men were more likely to weigh less than their UBW, DBW-, and DBW+. These findings suggest that HIV positive men, unlike HIV-positive women, may start out with weights that place them at increased risk of complications from weight loss.

I'd heard of reports related to gender variations in body composition changes and thought it might be useful to see how the weight status of our food bank clients differed. Two- hundred and nineteen of the 808 individuals that were screened for nutritional risk sought nutrition counseling. Many clients were African American. Each client was questioned about their nutrition awareness, nutrition knowledge and eating habits. 

After analyzing the weight data I learned that a number of male clients preferred to weigh less than the standard accepted desirable body weight. Three out of the 40 female clients weighed less than 70% of their UBW and two of them were more than 20% below their DBW- and DBW+. All three had experienced alcohol and or substance abuse problems. One-third of the women and 2/3 of the men weighed less than their DBW-. The incidence of weight loss was even more apparent after inclusion of the 10% 'cushion factor'. 45% of the women and 81% of the men weighed less than their DBW+. Of those, 30% (12) of the women and 64% (55) of the men were less than 90% of DBW+.

Women were more likely to weigh significantly more than their DBW+. Excess weight in the women appeared to be either the weight level they had carried during their adult life or added weight that was not planned. Twenty-eight percent (11) of the women usually weighed more than 100% of DBW- and DBW+. 

Study observations revealed:

• Few clients knew how many calories they should consume each day to avoid weight loss.
• Many individuals consumed unbalanced, irregular meals that were unlikely to meet their caloric needs.
• Perceived body weight was underestimated by most men in the study group.
• Both genders experienced weight loss that put them at increased risk of HIV-related complications. 

• A majority of the clients in this study were not aware of their energy needs and therefore were more likely to experience weight loss.
• HIV positive men, unlike HIV-positive women, may start out with weights that place them at increased risk of complications from weight loss.
• If practiced, early nutrition screening, assessment, education and counseling could positively impact the weight status of HIV+ people.

• What are some of the things we can do to increase nutrition awareness in HIV+ people who do not know the importance of nutrition?
• How can we further impress the need for nutrition intervention in food-related facilities?
• What is the best way to help homosexual men change their misguided idea of perceived DBW?
• What is the best method to use when counseling morbidly overweight HIV+ women?
• What are some of the things that we can do to impress upon women that they need to seek early and continued nutritional services for themselves? 

The purpose of this study was to document and evaluate variations in the weight status of individuals with HIV and AIDS.  Data were collected for a period of four months on clients at all stages of HIV disease. A total of 219 clients received nutritional services.  Of those, 126 clients, 86 men and 40 women, participated in nutritional assessments which included weight status documentation. Documentation of weight status included current body weight, usual body weight (UBW), % of UBW, % of desirable body weight for an HIV-negative status (DBW-), and % of DBW for an HIV-positive status (DBW+).

Weight status indicators were analyzed and percentages were calculated.  Data analysis reveals that 38% of the men and 40% of the women weighed less than 90% of their UBW.  A total of 34% of the men and 20% of the women weighed less than 90% of their DBW-. The minimum of UBW was 70% for the men and 64% for the women.  Nineteen percent of the men and 53% of the women weighed more than 100% of their DBW+. The highest percentage for DBW+ was 169% for the men and 215% for the women.

Study findings suggest that: 1) many HIV-positive individuals experience weight loss; and 2) for this group of individuals, women were more likely to weigh above their DBW than men. These findings support previous research suggesting that HIV-positive women, unlike HIV-positive men, may start out with weights that are higher than their DBW.

Article- HIV/AIDS Nutrition Guidelines Panel
by Edwin Krales, MS, CDN