HIV Nutrition Counseling Basic Principles

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HIV Nutrition Counseling Basic Principles

• By Divya L. Selvakumar, MPH
• Nutrition Consultant
• World Vision, Inc.

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HIV Nutrition Therapy

• Healthy eating principles
• Food and water safety issues
• Prenatal nutrition/breastfeeding issues
• Nutrition strategies for symptom management
  e.g. focus/goals, commitment, dietary habits,
  outcomes
• Food/drug interactions
• Psychosocial issues
• Alternative feeding methods e.g. feeding tubes,
  IV, home-made baby foods instead of breastfeeding
• Nutrition supplementation e.g. iron, zinc,
  folic acid, vitamins, etc.
• Evaluation

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Major Factors in Counseling

• Psychosocial factors depression, abuse,
  dementia, or other psychiatric problems that
  could interfere with proper eating habits
• Educational factors understanding and awareness
  of nutrition towards self and family/children
• Living environment homelessness, food access and
  availability, access to cooking
  utensils/stove/village kitchen
• Financial factors poverty and the ability to
  shop, grow and to prepare food
• Cultural factors food preferences and ethnic
  background, food customs

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HIV/AIDS Complications

• Inadequate intake of nutrients
• Poor absorption of nutrients
• Altered metabolism of nutrients
• AIDS wasting syndrome extremely low energy
  intake and chronic malnutrition
• Lipodystrophy (LDS) redistribution of fat mass,
  excess or loss of fat

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PES (Problem, Etiology, Signs/Symptoms)

• Problem Diagnostic label (usually determined by
  physician)
• Etiology cause/contributing risk factor as
  presented by evidence (e.g. opportunistic
  infections)
• Signs or Symptoms defining characteristics (e.g.
  incessant cough, constant fatigue, severe
  diarrhea, etc.)

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ABCDs of HIV Nutrition Counseling

• A Anthropometric values
• B Biochemical or lab values
• C Clinical values
• D Dietary Practices

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Anthropometrics

• Height
• Weight
• a) IBW ideal body weight (give out chart)
• b) BMI body mass index
• (weight (lbs) X 705) (height (inches))²
• c) Percentage of IBW ()
• Hip and waist circumference
• Physical appearance and functional status

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Biochemical

• Hemoglobin
• Normal range 14-18 g/dl (men), 12-16 (women)
• Hematocrit
• Normal range 40-54 (men), 37-47 (women)
• Glucose (normal range) 60-120 mg/dl
• Albumin (normal range) 3.2-5.5 g/dl
• T-cell count (range varies)
• the lower the CD4 cell count, the higher the risk
  of infections ranging from skin/lung,
  bacteria/sinuses to opportunistic infections

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Clinical

• Current medications
• Current medical status
• Risk category low, moderate, high
• Usage of alternative therapies
• Opportunistic infections
• Co-morbid conditions TB, CHD, malaria, etc.
• Nausea, vomiting, constipation, diarrhea,
  heartburn symptoms
• Symptoms of GI stress/malabsorption

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Dietary

• Food intolerances
• Altered taste and smell, nausea
• Adequate amount of serving sizes for all food
  groups (protein, dairy, carbohydrates, etc.)
• Current intake recorded daily
• Macronutrients and micronutrients supplements
• Cultural and ethnic preferences towards food and
  diet

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HAART (Highly Active Anti-Retroviral Therapy)

• Very effective in prolonging life span and
  reducing HIV related illnesses
• Side effects common depending on type of
  medication, ART (e.g. nausea, sore mouth, etc.)
• Documentation needed on nutrition intake from
  HAART
• History of patients reaction towards HAART

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Goals of HIV Nutrition Screening

• Find if a more detailed screening is needed
• Immediate identification of patients in the
  following categories
• a) Malnourished
• b) Nutritionally at risk
• c) Borderline nutritionally compromised
• d) In need of further analysis

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Counseling Overview

• Introduction name, what you do, purpose of
  visit
• Development and establishment of climate of
  trust, be professional in your approach
• Positive body language smile, sitting straight
  and making firm eye contact
• Cheerful and pleasant disposition
• Display of compassion and humility
• Cultural sensitivity and awareness of ethnic
  background
• Ask simple and open-ended questions that will
  produce the maximum amount of information from
  each patient

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First Task Diet Analysis

• 24-hour dietary recall
• a) Breakfast, lunch, snacks, dinner
• b) May take time, but is necessary
• Analysis of serving sizes pertaining to HIV/AIDS
  patient requirements for diet
• Compare and assess if serving sizes of each food
  group is too high or too low
• Sometimes cannot be performed due to following
  reasons patient in severe pain, unresponsive,
  noncompliant, hostile, confused, or has amnesia

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Serving Sizes for PLWHAs

• Protein Males 5-6 servings,
• Females 4-5 servings
• Fruits and Vegetables 5 servings/day
• Fats 6 servings/day
• Carbohydrates 6 servings/day
• Dairy 2 servings/day

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HIV/AIDS Food Pyramid
Dairy 2 servings
Fruits 2 servings
Vegetables 3 servings
Fats and Oils 6 servings
Carbohydrates, Whole-Grains 6 servings
High Protein Foods Males 5-6, Females 4-5
servings
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Serving Sizes Mozambique and Ethiopia

• Carbohydrates
• 1 cup of rice (Mozambique) 2 servings
• 1 slice of medium bread 1 serving
• 1 cup of maize (Mozambique 2 serving
• 1 small injera (Ethiopia) 1 serving
• 1 large fatira (Ethiopian pancake) 2 servings

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Serving Sizes, cont.

• Vegetables
• 1 cup of cooked vegetables 2 servings (any
  type)
• 1 cup of raw vegetables 1 serving (any type)
• Fruits
• 1 medium banana 1 serving
• 1 medium orange 1 serving
• 1 slice of pineapple, mango or papaya (other
  fruit) 1 serving

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Serving Sizes, cont.

• Protein Ethiopia and Mozambique
• ½ cup of nuts (any kind) 1 serving
• Chicken, fish or meat (lamb/beef) whole hand is
  2 servings, palm is 1 serving,
• 2 eggs 1 serving
• 1 cup of beans or lentils 2 servings
• Dairy
• 1 slice of cheese (Mozambique) 1 serving
• 1 ½ cup of cottage cheese (Ethiopia) 1 serving

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Subjective (General Overview)

• Reason for referral e.g. HIV, HIV
  complications, etc.
• Complaints or concerns
• Common problems e.g. nausea, vomiting,
  constipation, diarrhea, heartburn, lack of
  appetite, sore mouth, or other complaints

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Objective

• Weight
• a) CBW (current body weight)
• b) IBW (ideal body weight)
• c) Percentage () of IBW (CBW) (IBW)
• d) BMI weight (kg) ht (meters)²
• Height (centimeters)
• Labs hemoglobin/hematocrit, glucose, albumin,
  T-cell count
• Vitamin Supplements MVI, iron, calcium, etc.
• Physical Appearance and Functional Status

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Assessment

• Risk low, moderate or high
• Exercise light, moderate, heavy
• Drugs/Smoking/Alcohol History Y/N
• Food safety issues
• Factors involved psychological, finance,
  educational, cultural, living environment

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Risk Categories of HIV/AIDS patients

• Low risk little or no nutrition problems
  present, screening by dietitian or nutrition
  counselor as needed
• Moderate risk possible LDS or other
  complications, suffers often from N/V/D/C/H,
  screening by dietitian/counselor bi-monthly
• High risk greater than 10 loss of weight, two
  or more medical co-morbidities, severely
  dysfunctional psychosocial issues, screening to
  be done within a week

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Plan (Recommendations)

• Recommendations
• a) Simple and easy to follow for the
• patient
• b) Specific, clear, and concise
• c) Should include follow-up and contact if
  there are any problems or issues that may arise
  in the future
• d) Culturally sensitive and within means

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Conclusion

• Treat every patient with kindness, compassion and
  humility
• Be gentle, patient, firm and understanding
• Expect the unexpected
• Be as neutral in your views as possible

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References

• HRSA Care Action, Providing HIV/AIDS Care in a
  Changing Environment, August 2004
• http//hab.hrsa.gov/publications/aug04/
• Schieferstein, Christine and Thomas Buhk. Chapter
  6 Management of Side Effects. HIV Medicine,
  2007.
• http//www.hivmedicine.com/textbook/nw.htm
• Personal Notes by Divya Selvakumar, MPH.
  (2005-present).

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THANK YOU!