film producer with hiv infection final
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8/10/2019 Film Producer With HIV Infection Final
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Film Producer
with HIVInfection
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Case Study
Three years ago, Darrell Meckler, a 34 year old film
producer, sought medical help when he began feeling run-downand developed a painful white fungal infection over his mouth
and tongue. The presence of thrush, recent weight loss, and
anemia alerted Mr. Meckler's physician to the possibility of HIV
infection. When Mr. Meckler tested positive for HIV, he and his
family and friends were devastated by the news, but those close
to him have remained supportive. During the three years since
Mr. Meckler began antiretroviral drug therapy, he has
maintained his weight but has also developed lipodystrophy and
hypertriglyceridemia. Mr. Meckler is 6 feet tall and currently
weighs 185 lbs. He occasionally develops diarrhea and
sometimes anorexia.
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HIV – Human immunodeficiency
virus
it attacks the immune system and
disables a person’s defenses against
infections and certain cancers. Patients
may expect an ever-worsening course of
illness and possibly death. In recent
years, however , treatment options have
expanded and patients have benefited
by vast improvements of quality. life.
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The disease has still no cure, but
remarkable progress has been made in
understanding and treating HIV infection.
Without a cure, the best course is prevention.
HIV is most often sexually transmitted and can
be spread by direct contact with contaminated
body fluids, such as blood, semen, vaginalsecretions, and breast milk.
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CONSEQUENCES OF HIV
HIV infection destroys immune cells that have a protein
called CD4 + T cells because the presence of CD4 is a primarycharacteristic. Early symptoms of HIV infection are nonspecific
and may include, fever, sore throat, malaise, skin rashes,
nausea, muscle and joint pain and diarrhea. Afterward, many
people remain symptom-free for five to ten years or evenlonger. However, if the HIV infection is not treated, the
depletion of t- cells eventually increases the person’s
susceptibility to opportunistic infections, that is infection
caused by microorganisms that normally do not cause disease
in healthy individual.
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The term Aids applies to the
advanced stages of HIV infection, in which
the inability to fight illness allows anumber of serious diseases and
complications to develop such AIDS-
defining illness include severe infections,certain cancers, and wasting of lean
tissue.
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Nutrition in Practice1a) Describe lipodystrophy and discuss its typical pattern in people who have
HIV infection.
Lipodystrophy is a problem with the way the body produces, uses, and stores fat. It is
also called fat redistribution. Since the widespread use of antiretroviral theraphy
began, the numbers of HIV positive people with lipodystrophy has increased.
Today, lipodystrophy occurs in 30% to 50% of people who are infected with HIV.
Abnormalities of Lipodystrophy:
1) Fat build up or Fat redistribution ( lipohypertrophy, lipoaccumulation, or
hyperadiposity)
- is when fat accumulates in certain areas of the body.
- Some people see the amount of visceral fat ( fat deep within the body ) around their
gut increase significantly.
- The medical term for this is LIPOHYPERTROPHY ( excessive fat growth ).
- Increased dorsocervical fat pads : a buildup fat on the back of the neck and
shoulders, sometimes called “ buffalo hump” has also been seen, as well as
increased fat tissue in the breasts. Some people have also reported round,
movable, flattened lumps of fat under the skin (lipomas).
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• Abdomen ( central obesity )
• Breasts ( occurs in both men and
women )• Back of the neck and shoulders (
buffalo hump )
• Fatty growths in different partsof the body ( lipomas )
2) Insulin resistance
Obesity is characterized by increased body adiposity and leads to insulin
resistance.
Paradoxically, some conditions characterized by a paucity of fat alsocause insulin resistance, namely the syndromes of lipoatrophy.
The resemblance between the metabolic abnormalities of these extreme
states of adiposity underscores the importance of fat tissue in energy
homeostasis.
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1b) What adjustments in treatment and lifestyle may be helpful?
TREATMENT
1) HAART : HAART induced adipocyte inflammation, oxidative stress and
macrophage infiltration, as well as altered adipocyte function and
mitochondrial toxicity, have been shown to be central to the development of
HIV-associated lipodystrophy syndrome (HALS).
1) Appetite stimulant
• MEGESTEROL – it can be used as an appetite stimulant for people
experiencing loss of appetite and weight loss. It may help relieve bone pain,
and it can improve appetite and weight gain.
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•DRONABINOL – is a man-made form of cannabis (also known as marijuana).It is also used to treat loss of appetite and weight loss in patients with HIVinfection.
3) Testosterone and Human Growth Hormone
This human growth hormone generates some changes in our body.
It decreases fat mass and increases muscle mass.
Testosterone also decreases body fat, increases lean body mass and increases
endurance.
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LIFESTYLE
1. Physical activity / resistance training
- Lifestyle modification (smoking, diet, exercise).
- Exercise is also recommended although consistent changes in plasma lipids will notbe seen in the short-term.
- Regular exercise should be encouraged to improve metabolic status.
- Lifestyle modifications alone may not be sufficient and may need to be implemented
along with pharmacotheraphy.
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2. Dietary management
A diet with :
High CHON
Trans-fat and less fiber A Mediterranean diet
High in Omega-3
Fresh fruit
Vegetables
A balanced low-fat
Low CHO diet is preferable since hypertriglyceridemia is presentin the patient.
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2a) What strategies may improve his problems with diarrhea and anorexia?
Anorexia resulted from thrush and dysphagia
• Use cold or frozen foods; they are often soothing.
• Try soft foods such as ice cream, milk shakes, bananas, applesauce,
mashed potatoes, cottage cheese, and macaroni and cheese.
• Avoid foods that irritate mouth sores such as citrus fruits and juices,
tomatoes and tomato-based products, spicy foods, foods that are very
salty, foods with seeds ( such as poppy seeds and sesame seeds ) that can
scrape the sore, and coarse foods such as raw vegetables and toast.
• Ask your doctor about using a local anaesthetic solution such as lidocaine
before eating to reduce pain.
• Use a straw for drinking liquids in order to bypass sores
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Anorexia from lost of appetite
• Eat small meals and snacks at regular times each day.
• Eat the largest meal at the time of the day when you feel the best.
• Include nutrient-dense foods in meals and consume them before other
foods
• Indulge in favorite foods throughout the day. Serve foods attractively.
• Avoid drinking large amounts of liquids before or with meals.
• Eat in a pleasant and relaxed environment. Eat with family and friends
when possible.
• Listen to your favorite music or enjoy a program on tv while you eat.
• Take a walk before you eat.
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Diarrhea
• Drink plenty of fluids. Salty broths and soups, diluted fruit juices andsports drinks are good choices. For severe diarrhea, try oral rehydrationformulas that are commercially prepared.
• Avoid foods and beverages that increase gas, such as legumes, onions,vegetables of the cabbage family, foods that contain sorbitol or mannitol,and carbonated beverages.
• Avoid high-fat foods if you are fat intolerant.
• Avoid caffeine.
• Eat smaller meals and eat more frequently.
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2b) Suggests reasons why people with HIV infection may develop diarrhea
and anorexia.
Most people who are suffering from HIV infection will have ongoingproblems regarding wasting and weight loss. The wasting is associatedwith HIV infection which has many causes such as inadequate food intakeand anorexia.
EMOTIONAL DISTRESS, PAIN, AND FATIGUE: The physical and socialproblems that accompany chronic illness may cause fear, anxiety, anddepression, which contribute to anorexia. Pain and fatigue, which may beassociated with some disease complications, can cause anorexia anddifficulty with eating.
ORAL INFECTIONS: The oral infections associated with HIV infection suchas THRUSH ( Herpes Simplex Virus ) can cause discomfort and interfereswith food consumption.
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RESPIRATORY DISORDERS: Respiratory infections, including pneumonia
and tuberculosis, are common in people with HIV infection. Symptoms
often include chest pain, shortness of breath, and cough, which interfere
with eating and contribute to anorexia.
MEDICATIONS: The medications given to treat HIV infection, other
infections, and cancer often cause anorexia, nausea and vomiting, altered
taste sensations, food aversions, and diarrhea.
GI TRACT COMPLICATIONS: Complications involving the GI tract may result
from opportunistic infections, medications, or the HIV infection itself. In
addition to the oral infections described previously, infections commonly
develop in the stomach and intestines. Advanced AIDS is often
accompanied by characteristic changes in the lining of the small intestine,likely caused by GI infection: the villi appear shortened and flattened, and
the absorptive area is substantially reduced. These changes contribute to
malabsorption, steatorrhea, and diarrhea.
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As described earlier, many patients are unable to tolerate
the medications used to suppress HIV and develop nausea,
vomiting, and diarrhea. Furthermore, medications that treat
GI viral, parasitic, and fungal infections contribute to bacterial
overgrowth. Thus HIV-infected patients face an extremelyhigh risk of malnutrition due to the combination of intestinal
malabsorption, bacterial overgrowth, and nutrient losses from
vomiting and diarrhea.
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3a) Explain why an HIV infection can lead to wasting as the
disease progresses to the later stages.
Even with effective treatment of HIV infection, weight
loss and wasting are ongoing problems for HIV-infected
patients.
The Centers for Disease Control defines AIDS-related
wasting syndrome as a 10% weight loss within a six-month
period accompanied by diarrhea or fever for more than 30days without a known cause. The wasting has been linked
with accelerated disease progression, reduced strength and
fatigue.
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In later stages of AIDS, wasting is severe and
increases the risk of death. Much as in cancer, the
wasting associated with HIV infection has many
causes such as:
Anorexia and inadequate food intake
altered metabolism
malabsorption
chronic diarrhea
diet-drug interactions
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3b) How should Mr.Meckler's diet change if wasting becomes a
problem for him?
A regular program of resistance training can
improve muscle mass and strength and correct
some of the metabolic abnormalities (altered bloodlipids and insulin resistance) that are common in HIV-
infected patients. The medications megesterol
acetate and dronabinol are sometimes prescribed to
stimulate appetite and help with weight gain.
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DIET RY M N GEMENT
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DIET MANAGEMENT RATIONALE
HIGH CALORIE
- Avoid foods that increase
gas.
- For energy supply and
wasting
HIGH PROTEIN - provide lean meats- For energy supply and
wasting
LOW FAT / FAT Restricted
- more on unsaturated fats
- give low fatcold milk or
shake
- for abnormal blood lipid
levels
- diarrhea
- for hypertriglyceridemia
BLAND DIET- can be in a form of
enteral/parenteral feeding
- because of thrush
- for malabsorption and GI
complication
COLD & LIQUID DIET
- full in energy and
nutrients but cold in
temperature and soft in
consistency
- thrush and dysphagia
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Vitamin Supplementation
A / Beta Carotene
- improve immunity
- enhances response, CD4
Tcells
B Vitamins - reduced lymphoid tissue
C - enhance function
E- enhances immunity, skin
test response
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Mineral Supplementation
Cu- due to metabolic effectthat decreases the level
due to DM
Fe- due to metabolic effect of
HIV treatment
Zn
- Lost of T-cell immunity
- due to metabolic effect of
HIV treatment
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