Samsuridjal Djauzi, Nanang Sukmana

Nutritional Problems Nutritional Problems Among People Living with Among People Living with

HIV/AIDSHIV/AIDS

Division Allergy Clinical ImmunologyDept. of Medicine, Faculty of Medicine University of Indonesia

Jakarta

Estimation Estimation

2002 (90.000-120.000)2006 (170.000-210.000)2008 medio 270.000Most rapid increase in ASIA region beside China and Vietnam Most of AIDS cases among low income and low education group

AntibioticAntiviral

Immunity

Infection

NUTRITION

Sizer

F and Whitney E. Nutrition: concepts and controversies, 10th

ed, 2006

Situation in hospitalsSituation in hospitals

Late diagnosisSevere and multiple opportunistic infections (Fungal infection of GI, TB, CNS infection) Under nourished

Symptoms of malnutrition in Symptoms of malnutrition in patient with HIV/AIDS include :patient with HIV/AIDS include :

Weight lossWeight lossLoss of muscle tissue and subcutaneous fatLoss of muscle tissue and subcutaneous fatVitamin and mineral deficienciesVitamin and mineral deficienciesReduced Immune competenceReduced Immune competenceIncreased susceptibility to infectionIncreased susceptibility to infection

The Clinical ContextThe Clinical ContextInfections affect nutritional status by reducing dietary intake and nutrient absorption and by increasing the utilization and excretion of protein and micronutrients as the body responds to invading pathogens

Anorexia, fever, and catabolism of muscle tissue frequently accompany the acute phase response.

Infections also result in the release of pro-oxidantcytokines and others reactive oxygen species. This leads to the increased utilization of antioxidant vitamins (vitamin E, vitamin C, β carotene) as well as the sequestration of several minerals (iron, zinc, selenium, manganese, copper) that are used to form antioxidant enzymes.

HIV and NutritionHIV and Nutrition

Malnutrition is serious danger for people Malnutrition is serious danger for people living with HIV/AIDS. The risk of living with HIV/AIDS. The risk of malnutrition increases significantly during malnutrition increases significantly during the course of the infection. the course of the infection.

Distribution of opportunistic Distribution of opportunistic infections (by infections (by occurenceoccurence) )

n=700n=700

Opportunistic infection %candidiasis(oropharyngeal, esophageal) 40Pulmonary tuberculosis 37.1Chronic diarrhea 27.1Bacterial pneumonia 16.7Toxoplasma encephalitis 12Extrapulmonary tuberculosis 11.8Herpes zoster 6.3Bacterial endocarditis 5.7

Pokdisus 2004

CNS infectionCNS infection

Nausea, severe headache

Unconcious

Convulsion

Chronic diarrhea among Chronic diarrhea among adult patients (120 samples)adult patients (120 samples)

Very common Etiology: Blastocystosis(62,6%),Cyclosporiosis(5,7%),Cryptosporidiosis (4,1%),Giardiosis(0,8%), multiple parasitic infection (9,0%)

(A. Kurniawan et al)

Side effect of drugsSide effect of drugs

Antituberculosis

Antiretroviral

Many patients consume more than

10 drugs

Poor nutritional status may Poor nutritional status may have multiple causes:have multiple causes:

Depressed appetite, poor nutrient intake and Depressed appetite, poor nutrient intake and limited food availabilitylimited food availabilityChronic infection, Chronic infection, malabsorptionmalabsorption, metabolic , metabolic disturbances and muscle and tissue disturbances and muscle and tissue catabolismcatabolismFever, nausea, vomiting and diarrheaFever, nausea, vomiting and diarrheaDepressionDepressionSide effects from drugs used to treat HIV Side effects from drugs used to treat HIV related infectionrelated infection

Anne Anne RivaidaRivaida

There was significant correlation There was significant correlation between Zn plasma level and between Zn plasma level and

CD 4 lymphocytes count.CD 4 lymphocytes count.(n : 52)(n : 52)

T.M. T.M. MariniMarini

No correlation was found betweenNo correlation was found betweenPlasma Plasma VitVit

E concentration andE concentration and

CD 4 in HIV/AIDS patients.CD 4 in HIV/AIDS patients.(n: 52)(n: 52)

Even in out patient clinic

under nutrition is high (36%)

Nutritional Status (BMI)Nutritional Status (BMI)

TM. Marini, et al

BasuriBasuri

The correlation was found betweenThe correlation was found betweenPlasma Beta carotene concentration Plasma Beta carotene concentration

and and CD 4 in HIV/ AIDS patients.CD 4 in HIV/ AIDS patients.

(n : 52)(n : 52)

The vicious cycle of Micronutrient The vicious cycle of Micronutrient Deficiencies and HIV PathogenesisDeficiencies and HIV Pathogenesis

Insufficient dietary intakeMal-absorption, diarrheaAltered metabolism and nutrient storage

Increased HIV replicationHastened disease progressionIncreased morbidity

Nutritional deficiencies

Increased oxidativeStressImmune suppression

Good nutrition cannot cure aids or Good nutrition cannot cure aids or prevent HIV infection, but it can help to prevent HIV infection, but it can help to maintain and improve the nutritional maintain and improve the nutritional status of a person with HIV/AIDS and status of a person with HIV/AIDS and delay progression of HIV disease, delay progression of HIV disease, thereby improving the quality of life.thereby improving the quality of life.

ConclusionConclusion

Nutritional is one of serious problems Both at OPD and in patient under

nutrition is frequent ARV is available but nutrition problem should be solvedNetworking between medical profession is needed