Definitions

What is HAART?

“Highly active antiretroviral therapy” – it is a combination of antiretroviral (ARV) medications that inhibit the various segments of the life cycle of HIV infection effectively – HAART generally includes the use of three or more ARV medications

What is CD4?

CD4 cells are immune cells and they are one of the primary targets of HIV for infection. CD4 is a marker found predominantly on helper T cells that interacts with MHC class II molecules (glycoproteins found on nucleated cells; they present antigens to helper – CD4 – T cells) on antigen-presenting cells

What is VL?

“Viral load” – it is the level of virus or viral markers measured in the blood

Anatomy/Physiology

Briefly discuss the functions of the immune system.

The immune system is the body’s natural defense against foreign materials that have penetrated the skin or mucous membranes. When antigens get through the body’s first line of defense – the skin, mucous membranes, and GI tract – the immune system responds by releasing phagocytes and lymphocytes to defend the body against infectious diseases.

What are some micronutrients that are important in immunity?

Vitamin C

• Needed for the growth and repair of tissues throughout the body
• Involved in wound healing and the repair and maintenance of healthy cartilage, bones, teeth and skin.
• Works as an antioxidant by fighting free radicals in the body which may help prevent or delay certain cancers and heart disease and promote healthy aging
• Evidence shows that high doses of vitamin C can help decrease the length of cold symptoms

Vitamin A

• Involved in maintaining protective barriers such as the skin and lining of the intestinal and respiratory tracts, most of which are epithelial tissue – without vitamin A, these tissues break down, allowing bacteria and viruses to enter the body and cause infection
• Needed for the production of lymphocytes (functional immune cells) and antibodies – without these the body would not be able to mount an effective immune response against pathogens

Vitamin E

• Antioxidant
• Enhances immune system health

Vitamin B₆

• Studies have shown that deficiency of this vitamin is linked to impaired immune function
• Involved in biochemical pathways essential to proper immune function

Folate

• Involved in DNA synthesis and repair

Iron

• Iron is necessary for immune cell proliferation and maturation, particularly lymphocytes, associated with the generation of a specific response to infection

Selenium

• Boosts the antioxidant properties of vitamin E

Zinc

• Involved in protein and DNA synthesis
• Regulates and improves immune function

What are some of the metabolic abnormalities that can occur in patients treated with HAART?

Metabolic complications include diarrhea, nausea, and vomiting. Lipodystrophy, hyperglycemia and onset of diabetes, liver toxicity including liver failure, pancreatitis, and neuropathy are all potential complications of HAART.

What are some of the physical changes that can occur in patients treated with HAART?

Lipoatrophy (subcutaneous fat wasting of limbs, face, and butt) and lipohypertrophy (accumulation of visceral, abdominal, upper back, and breast fat) can occur.

Pathophysiology

What are some opportunistic infections commonly seen with HIV infection?

Pneumocystis(pneumonia), Toxoplasma gondii (encephalitis), Mycobacterium tuberculosis infection, disseminated Mycobacterium avium complex disease, Streptococcus pneumonize infection, influenza A and B virus infection, Histoplasma capsulatum infection, Human Papillomavirus (HPV) infection, hepatitis A and B virus infection, malaria

How do these impact nutritional status?

These opportunistic infections further assault the body’s normal functions and are associated with nutritional decline and mortality. They can initiate a reduction in food intake and lead to episodic wasting.

Drug Therapy

Discuss the use of the following classifications of drugs. Include indication for use with AIDS patients, and pertinent drug/nutrient interactions.

Drug Classification	Indication for use with AIDS patients	Drug/nutrient interactions
Appetite Stimulants	Prevention and treatment of wasting	Can increase LDL cholesterol   May cause weight gain from increased fat mass
Protease Inhibitors	Antiretroviral (anti-HIV) medication – used to lower viral load – suppresses HIV to slow the progression of the infection and reduces the risk of infecting others	Can cause lipodystrophy, hyperlipidemia, type 2 diabetes mellitus, and kidney stones   Can be taken with or without food, but avoid taking with high-fat meals because that makes it harder for the body to absorb   Take with an 8 oz. glass of water
Nucleoside Reverse Transcriptase Inhibitors	Antiretroviral (anti-HIV) medication – used to lower viral load – suppresses HIV to slow the progression of the infection and reduces the risk of infecting others	Can cause lactic acidosis, neuropathies, hypersensitivity reactions, anemia, neutropenia, and pancreatitis   Adequate folate and vitamin B12 levels are necessary to prevent toxicity
Non-nucleoside Reverse Transcriptase Inhibitors	Antiretroviral (anti-HIV) medication – used to lower viral load – suppresses HIV to slow the progression of the infection and reduces the risk of infecting others	Can cause hyperlipidemia
Fusion Inhibitors	Antiretroviral (anti-HIV) medication – used to lower viral load – suppresses HIV to slow the progression of the infection and reduces the risk of infecting others	Can cause GI distress (nausea, diarrhea), fatigue, pneumonia, and pancreatitis
Anabolic Agents	Prevention and treatment of wasting	Increased appetite   Can increase LDL cholesterol   May cause weight gain from increased fat mass

Nutritional Management

Discuss the importance of educating immunosuppressed patients on safe food handling techniques.

Providing education on safe food handling techniques is important because immunosuppressed patients are more susceptible to infections. They’re body’s immune system cannot properly fight off bacteria and infections, so if they consume contaminated foods their body may not be able to fight off the infection, and severe complications or death may occur as a result.