Position of Dietitians of Canada and the American Dietetic Association: Nutrition intervention in the care of persons with human immunodeficiency virus infection.
Human immunodeficiency virus (HIV) targets the immune system, making an infected person susceptible to infection and neoplasm because of an impaired ability to mount an adequate immune response. Malnutrition and its complications can further render an HIV-infected person susceptible to opportunistic infection, reduce effectiveness of and increase tolerance to medications and other therapies. Though effective antiretroviral treatments have dramatically reduced death rates in Canada and the United States, HIV-infected individuals are faced with a lifetime of vigilant polypharmacy to control HIV and associated complications. Malnutrition, various forms of tissue wasting, fat accumulation, increased lipid levels, and risk of additional chronic disease have become central issues in health care plans. Nutrition evaluation and medical nutrition therapy (MNT) should be an integral part of the ongoing health care of persons with HIV disease to address these multiple factors that can contribute to health decline. Medical nutrition therapy involves both the assessment and appropriate treatments to maintain and optimize nutritional status. Nutrient-based treatment may include diet therapy, counseling, or the use of supplemental nutrition (oral, enteral, and/or parenteral delivery of nutrients). Symptoms that threaten nutritional status may require both dietary and medication interventions. Metabolic alterations that result in malnutrition may require additional therapies to achieve optimal nutritional status such as hormonal and inflammatory modulation.