Human Immunodeficiency Virus and Acquired
Immunodeficiency Syndrome
Lauren Walker
Dietetic Intern
Andrews University
March 19, 2015
Acquired immunodeficiency syndrome, more commonly referred to as AIDS, is caused by a
manifestation of the human immunodeficiency virus (HIV), a type of retrovirus that functions completely
opposite of typical DNA. 1 Scientists had discovered in 1981 that the disease could be spread through
blood or sexual activity.1 The dominant mode of transmission of the virus, accounting for 85% of all
cases, is found in South Africa, occurring between heterosexual partners. This results in a baby born with
the HIV virus, or a mother passing the HIV virus to her infant through breast milk. The HIV spread has
also been verified in injectable drug users, and homosexual intercourse.
There are two subtypes of HIV, HIV-1 and HIV-2. HIV-1 is the most common subtype of the
retrovirus. HIV can only infect cells bearing the CD4 receptor. 2 In a multistep process, the HIV virus
invades the host cell, and starts to integrate its genetic material into the cell’s existing genetic material.
Thus, resulting in CD4+ cell destruction, which is the hallmark sign of HIV and AIDS. The immune system
initially fights against the infection, but HIV evades destruction, because it starts to mutate the cellular
structure itself, rendering the proteins needed for viral attack useless. 2
The disease has four stages: (1) acute HIV infection; (2) asymptomatic chronic HIV infection; (3)
symptomatic HIV infection; and (4) AIDS, or advanced HIV. 3 If left untreated, the disease will progress
quickly. The leading causes of death among people with HIV disease are infection, cancer, cardiac
disease, trauma, and liver disease.3 There may be a decrease in lean body mass without total body
weight change, Vitamin B12 deficiency, and these individuals may have increased susceptibility to
viruses found within food and water. Nutrition education should be provided to these individuals
regarding food safety and a low microbial diet, if needed.
HIV wasting syndrome is an AIDS defining condition referring to greater than 10% of involuntary
baseline body weight loss. Diarrhea and fever are commonly seen associated this syndrome, proving to
be difficult to manage. Therefore, the goals within medical nutrition therapy include maintaining or
restoring a healthy body weight, preserving optimal somatic and visceral protein status, and to minimize
any HIV or medication relation complications that interfere with nutrient intake and absorption. 3
Both the protein and caloric needs of a patient infected with HIV or AIDS will vary depending on
their health status, the stage of the disease, and medication or disease related complications. It is said;
however, that most patients with AIDS benefit when provided between 40 and 50 calories per kilogram
of current weight, or an additional 500 calories above their daily energy requirement. Protein
requirements for maintaining visceral and somatic protein stores range between 1 to 1.4 grams per
kilogram of current body weight. 1.5 to 2 grams per kilogram of current body weight is encouraged for
maintenance of visceral and somatic protein stores. 3
Dysguesia, thrush, herpes, and difficulty or pain with swallowing may present in the oral cavity
of an AIDS patient. Patients must be diligent with their oral care and may require parenteral or enteral
nutrition if unable to intake adequate amounts of nutrients by mouth. Soft, moist foods may be easier
for patients to swallow when having difficulty and nutrient dense intake should be enforced.3
Gastrointestinal diseases will also present in the AIDS infected patient. Some gastrointestinal
diseases may be a direct result of the ART provided to patients. Small bowel and large bowel enteritis
are common within the immunosuppressed AIDS population, and as expected, they are much more
receptive to bacterial infections.1 It can be difficult to pinpoint the etiology of the diarrhea in this
population due to the variation of causes (Bacteria, parasites, fungi viruses, drugs, antimicrobials, and
even vitamins). 3 Soluble Fiber supplementation, adequate fluids and electrolyte replacement, limiting
fat, avoiding lactose, limiting carbonated beverages, and incorporating small frequent meals into the day
are all nutrition interventions that can be implemented to alleviate AIDS-related diarrhea. 3
Patients receiving ART have reported pancreatitis, hepatic steatosis, lactic acidosis, and druginduced hepatotoxicity. End stage liver disease has now been confirmed as a common cause of
mortality within the HIV-infected population. 1 An HIV or AIDS patient with liver disease may need small,
frequent meals, a diuretic regimen, a carbohydrate controlled meal plan, and vitamin and mineral
supplementation.3
Malabsorption of fat, monosaccharides, disaccharides, nitrogen, vitamin B12, folate can all
occur within patients due to infections of the small bowel. It is recommended that these patients take a
multivitamin with minerals that supplies 100% of the RDAs. Additionally, b-complex vitamin
supplementation has also proved helpful. 3 Regarding malabsorption of fat, it may be advantageous to
prescribe prescriptive pancreatic enzymes with every meal and provide patient with MCT oil. If the large
bowel is infected, patients may present with malabsorption of fluids and electrolytes, and may benefit
from IV fluids being administered.3
Up to 30% of HIV-infected patients present with renal dysfunction.1,3 HIV-associated
nephropathy can prove problematic. The treatment usually involves immunosuppressive drugs such as
steroids and cyclosporine, further compromising the already low immunity that these patients have. 1 An
increasing number of AIDS and HIV patients are on dialysis. The protein requirements, sodium, fluid, and
potassium levels will need to be adjusted for these specific patients with renal failure.3
The deterioration of CD4+ count, the side effects of numerous HIV and AIDS related drugs, and
the catabolic nature of the disease itself all contribute to the general wasting away, and organ failure
that is experienced by patients affected by AIDS. Medical nutrition therapy for the AIDS or the HIV
infected patient is multifactorial, and will depend on the specific side effects and problems that the
patient presents with. Patients will need continuous medical nutrition therapy in the form of symptom
management, assessment of nutrient needs, and education regarding nutrient dense choices, and low
microbial foods unless contraindicated by renal or liver dysfunction.
BIBLIOGRAPHY
1. Marx JA, Hockberger RS, Walls RM. Rosen’s Emergency Medicine. 8th edition. Saunders;
2014:1751-1767
2. Walker BR, Colledge NR, Ralston SH, Penman ID. Davidson’s Principles and Practice of Medicine.
22nd edition. Elsevier; 2014: 387-410
3. Mahan LK, Escott-Stump S. Krause’s Food and Nutrition Therapy. 12th edition. St. Louis, Missouri;
Saunders; 2008:992-1018