Film Producer With HIV Infection Final

8/10/2019 Film Producer With HIV Infection Final

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Film Producer

with HIVInfection



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.





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.



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.



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.



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.



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).



• 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.





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.



•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.



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.



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.



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



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.



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.



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.



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.



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.



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.



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



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.



DIET RY M N GEMENT



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



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



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



video

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Documents

Film Producer With HIV Infection Final