Session 3:
Nutrition and HIV Medications
Nutrition Management with HIV and AIDS:
Practical Tools for Health Workers
Objectives
• Explain the importance of nutrition and
HAART
• Identify food effect or potential side effect
for each antiretroviral medication
• Counsel clients on food effects of
medications by using the food-medication
timetable
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 2
Why is Nutrition Important
with Medications?
• Improved treatment effectiveness and
efficiency
• Prevention of side effects
• Better adherence, means less resistance
• Improved quality of life
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 3
Effects of Malnutrition and HIV on
the Immune System
Malnutrition
HIV
 CD4 T-lymphocyte number
 CD8 T-lymphocyte number
 Skin sensitivity to infections
 CD4 / CD8 ratio
 Serologic response after immunizations
 Bacteria killing
Good
Nutrition
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
HAART
Slide 4
ARV vs. HAART
• ARV: antiretroviral medication refers to the
individual medications that are used to
inhibit the multiplication of retroviruses like
HIV
• HAART: highly active antiretroviral therapy
refers to the treatment regimens
recommended by leading HIV experts to
aggressively suppress viral replication and
progress of HIV disease
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 5
Modern (New) Therapies
• HAART: combination of 3 or more of the
following:
• Non-nucleoside reverse transcriptase inhibitors
(NNRTIs)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Protease Inhibitors (PIs)
• Therapies to treat opportunistic infections
• Ex: TB treatment, antifungal, antibiotics
• Malaria treatment
• Multivitamin/mineral supplements
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 6
Traditional Therapies
• Herbal remedies, teas/infusion, or high-dose
vitamin supplements
• Caution: some may interact with other medicines
or foods
• Ex: Avoid garlic supplements with Saquinavir
• Some therapies may be expensive, replace
food, and can cause liver damage (especially if
combined with other medications)
• Always ask clients what traditional therapies they are
taking
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 7
Food and Medication Interactions
• Food
(affects)
• Medication
(affects)
• Medications’
side effects
(affects)
• Medications +
(causes)
certain foods or therapies
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Medication absorption,
metabolism, distribution,
and excretion
Nutrient absorption,
metabolism, distribution,
and excretion
Food intake
and nutrient absorption
Unhealthy side effects
Slide 8
How Can Diet Help with Medications?
• Management of side effects
• Enhance flavour of foods
• Balanced meals help prevent side effects
and promote adherence
• Avoid alcohol use with medications
• Address food security issues with client
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 9
Pregnant and Lactating Women
• More food needed during pregnancy and
lactation
• Good nutrition status increases
effectiveness of HAART/medications and
reduces infant low birth weight
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 10
Infants and Children on HAART
• Increased nutrition/energy needs
• Greater risk for malnutrition, morbidity
(illness) and mortality (death)
• Closely monitor growth (weight and
height), clinical signs of malnutrition (i.e.
wasting, oedema) and feeding patterns
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 11
Common Side Effects from Medicines
•
•
•
•
•
•
•
Nausea, vomiting, diarrhoea
Poor appetite
Changes in taste
Metabolic Changes
Iron Deficiency Anaemia
Liver toxicity
Rash/skin problems
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 12
Metabolic Changes
• Lipodystrophy: changes in the way the body
makes, uses and stores fat. Two types:
• Lipoatrophy: loss of subcutaneous fat (fat under the
skin), mostly in arms, legs, buttocks, and face
• Lipohypertrophy: fat accumulation, mostly around the
abdomen, chest, and behind the neck
• Biochemical changes: high blood fat levels, high
blood sugar levels
• Increases risk of heart disease and diabetes
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 13
Metabolic Changes
• Associated ARVs
• d4T (stavudine)
• Possibly other NRTIs
• Protease inhibitors and
boosted PIs
• Early prevention, detection,
and treatment are important!
• Look for physical signs of
lipodystrophy/lipoatrophy
• Biochemical monitoring
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
C. Steinberg © ITECH, 2006
Slide 14
Dorsocervical Fat Pad
Source: Dominic C. Chow, MD, University of Hawaii; Larry J. Day, MD,
University of Michigan; Cecilia M. Shikuma, MD, University of Hawaii
“Buffalo hump” in HAART-treated patient
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 15
Central Fat Accumulation
Visceral fat accumulation, before
ART
Visceral fat accumulation, four
months after starting ART
Courtesy of Dr. Stefan Mauss
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 16
Dietary Considerations for
Metabolic Changes
• Reduce refined starches (e.g. maize, white
bread, pastas, sugar)
• Increase fibre from whole grains (e.g. oats,
mahangu, brown bread) and fresh fruits
and vegetables
• Eat more “good fats” from foods like oils,
avocado, and nuts and less “bad fats” from
butter and deep fried foods
• Exercise at least 45 minutes a day
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 17
Counselling Pre-HAART
•
•
•
•
•
•
What are client’s eating habits?
Number of meals per day?
What are common foods eaten?
Any times when food is not available?
Any recent weight loss? How much?
Any current medications (consider modern and
traditional medicines)?
• What are specific food-medication interactions or
common side effects of proposed ART regimen?
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 18
Counselling During HAART
• What is the client’s food-HAART schedule?
• What side effects does the client have?
• Has the client lost weight since beginning
HAART?
• Is the client taking other medications or
traditional therapies?
• If traditional therapies taken: in what form (pill),
what is cost, and do these replace meals?
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 19
Weight Gain on Effective HAART
and Nutrition Therapy
Photograph by: David Walton Copyright  2003 Partners In Health
Before HAART
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
After 1 year on HAART
Slide 20
Common HAART Regimens
• AZT/3TC/NVP (zidovudine – lamivudine –
nevirapine)
• AZT/3TC/EFV (zidovudine – lamivudine –
efavirenz)
• AZT/ddI/INV+r (zidovudine – didanosine –
indinavir+ritonavir)
• AZT/ddI/LPV+r (zidovudine – didanosine –
kaletra)
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 21
Sample Adult HAART Schedule
with Meal Plan
Time of Day
Food
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Medication
Slide 22
Food and Medication Table Activity
•
Questions to answer:
1. Is the diet adequate for the medication
regimen this person is taking?
2. What should be changed, if anything?
3. What are some side effects with the
medications?
4. What can you tell the client to do to prevent
or manage potential side effects?
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 23
Case Studies
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 24
Key Points
1. All persons need to have access to healthy
food, especially those on HIV medications
2. Counsel clients on food effects of their
medications
3. Help clients make a food-medication timetable
4. HIV medications can help a person with HIV
live longer, but not without proper nutrition
Session 3: Nutrition and HIV Medications
Nutrition Management with HIV and AIDS Training
Slide 25