NUTRITION SUPPORT AND THE HUMAN-IMMUNODEFICIENCY-VIRUS (HIV)

Nutritional support of patients with HIV or acquired immune deficiency syndrome (AIDS) has many similarities to other disease states in that the same nutritional products and techniques are used. Some patients with HIV, and many with AIDS without secondary infection, experience a metabolic milieu similar to patients with cancer cachexia. In providi ng dietary counselling to the HIV patient, we encounter many of the ob stacles that must be overcome to improve nutrition in cancer: anorexia , gastrointestinal discomfort, lethargy, and poor nutrient utilization , which limit the ability for nutritional repletion. When a secondary infection is superimposed on HIV, patients resemble more highly catabo lic trauma patients or patients in the intensive care unit (ICU), wher e, despite aggressive efforts to feed, there is usually a net nitrogen wasting leading to the more rapid development of cachexia. However, e ven in this setting, feeding will limit substantially net catabolism w hen compared to total starvation. Because the nutritional needs of HIV patients vary greatly, individual strategies have to be designed as t he patient moves through the stages of disease. Patients are generally able to consume adequate nutrition either as regular food or dietary supplements during the latency period of viral replication. Once secon dary infections become prevalent, artificial diets administered by tub e or by vein may be required during the period of active secondary inf ections, with dietary supplements often helpful during more quiescent periods. Patients with HIV are among the most challenging for clinicia ns providing nutritional support. Knowledge from treatment of patients with other diseases may be useful, but more data must be gathered on the unique aspects of aetiology and treatment of the anorexia, malabso rption, and ultimate wasting associated with AIDS.