Nutrición en enfermos con VIH / Nutrition for patients suffering from HIV

Realizamos el estudio en una consulta de enfermería de pacientes con el Virus de la Inmunodeficiencia Humana. La muestra la componen 108 pacientes.Analizamos las causas que provocan los problemas nutricionales, puesto que a los signos y síntomas derivados de la enfermedad se asocian infecciones oportunistas, que afectan directamente a los requerimientos nutricionales.Seleccionamos las variables que determinarán los parámetros generales de estudio nutricional: Parámetros antropométricos: peso, talla, pliegue tricipital; Parámetros bioquímicos: albúmina y ferritina; Parámetros clínicos: diarrea, vómitos, anorexia, fiebre, disfagia. Los resultados evidencian que en el parámetro bioquímico, en relación a los valores de albúmina, el 65,28 por ciento de los pacientes se encuentra en una fase de malnutrición severa. En el parámetro antropométrico, respecto al pliegue tricipital, el 16,8 por ciento del total de la muestra está en el rango de normalidad y el 52,64 por ciento se encuentra por debajo del percentil 10, indicando este resultado niveles importantes de caquexia.Próximamente publicaremos el estudio de las mismas autoras referido a los hábitos alimentarios de estos pacientes y su relación con el estado nutricional (AU)

Management of HIV-associated diarrhea and wasting.

Diarrhea, and associated weight loss, is a leading cause of morbidity in persons with HIV, occurring in 80% of those with HIV. Diarrhea and weight loss adversely affect immune function by increasing vulnerability to opportunistic infections. Clearly, both of these conditions have a disastrous effect on an individual's quality of life. Thus, treatment of these conditions should have a cause-centered focus and must be individualized.

Diarrhea and wasting conference summary.

With the advancement of the therapeutic management of the human immunodeficiency virus (HIV), changes in the manifestation and clinical presentation of the disease are also evident. Clinicians and patients are continually challenged by these changes because frequently they are the first individuals to encounter them. Thus, clinical questions raised by clinicians/practitioners can often guide the endeavor of researchers. In this summation, the authors, a research scientist and clinician, highlight the main themes of the current state of the science of diarrhea and wasting presented at the 12th Annual Association for Nurses in AIDS Care conference. The experiences of both authors will hopefully provide greater insight into the current state of diarrhea and wasting in HIV.

Management of antiretroviral-related nutritional problems: state of the science.

A number of new nutritional problems have been documented in HIV-infected persons treated with antiretroviral therapy, but only a limited amount of data exist on strategies to manage these problems. Initial studies have focused on drug therapy as the sole management strategy. Controlled trials are needed to confirm the benefits of drug therapy and to evaluate the usefulness of preventive measures, lifestyle changes, and complementary and alternative therapies in managing antiretroviral-related nutritional problems.

Management of antiretroviral-related nutritional problems: challenges and future directions.

Survival has been greatly enhanced with the adequate and effective treatment of HIV infection. Surviving and surviving well are important pieces of the disease management puzzle. Nutritional well-being has been closely associated with both survival and quality of life in HIV and other diseases. The effects and interactions of currently used antiretroviral therapies can compromise nutritional well-being. The challenges posed to researchers, clinicians, and patients in evaluating and treating nutrition-related effects of life-saving antiretroviral medications affect health care goals, recommendations, and decisions. Challenges include identifying emerging problems, prioritizing clinical problems, expediting the implementation of clinical trials, developing research-based interventions that are realistic and usable in practice, decreasing the time lag to incorporate research findings into practice, and developing or adapting evidence-based clinical guidelines. This article will explore these challenges, offer thought-provoking questions in the development of research and clinically viable solutions, and propose future directions for management strategies of antiretroviral-related problems.

Assessment of hunger and appetite and their relationship to food intake in persons with HIV infection.

Assessments of hunger and/or appetite are common methods of screening for development of illness-related anorexia. There are limited data to determine whether these methods predict actual food intake in persons with HIV disease. Therefore, the authors examined the relationship between self-reported food intake and subjective ratings of hunger and appetite in 31 adults with HIV infection. Participants also indicated presence of additional factors that can decrease amount of food eaten. Subjective ratings of appetite and hunger correlated with each other but not with food intake. Twenty-four additional factors that can affect food intake were reported to be present. The most common were illness-related and factors such as eating with friends or family. These results indicate that measures of hunger and appetite are not sufficient to screen for decreased food intake. Additional factors that can affect food intake should also be included in a comprehensive assessment of adults with HIV infection.

Nutritional status, symptoms experienced and general state of health in HIV-infected patients.

The aim of the study was to describe HIV-infected patients with respect to nutritional status, symptoms experienced, general state of health, and relevant medical and laboratory data. An additional aim was to study the relationships between some of these variables. On admission to an acute care hospital in Sweden, 25 HIV-positive men were consecutively included in the study. Medical data, anthropometric variables such as weight, height, body mass index (BMI) and percentage weight loss were studied. The following instruments were used: the subjective global assessment (SGA) was used to determine nutritional status; the oral assessment guide (OAG) was used for subjective assessment of the oral cavity; and the numeric rating scale (NRS) was used to assess the symptoms experienced. The Health Index (HI) was used to evaluate general state of health. The results showed that more than half of the patients had suspected/severe malnutrition; between 48% and 72% complained of moderate to severe symptoms of various kinds. Two thirds felt their general state of health was rather poor or very poor. Correlations showed that the lower the BMI, the worse the nutritional status (SGA); the greater the weight loss in percent, the worse the nutritional status (SGA); and the worse the general state of health (HI), the worse the nutritional status (SGA). In conclusion, it is important that nurses have good knowledge concerning nutritional problems in order to be able to detect these conditions at an early stage and/or to endeavour to prevent them.

Minimizing HIV/AIDS malnutrition.

HIV/AIDS malnutrition influences immune function, disease progression, and quality of life. Changes in dietary intake, altered metabolism, and malabsorption are among the mechanisms that contribute to the nutritional alterations seen in HIV/AIDS. Medical-surgical nurses can help their patients minimize HIV/AIDS malnutrition through early and ongoing assessment, which guides nutritional and pharmacologic interventions.

Malnutrition associated with HIV/AIDS. Part Two: Assessment and interventions.

Nutritional deficits can be forestalled through early assessment and intervention. Appropriate treatment may alter the continuum of deterioration and improve a patient's quality of life. This article reviews the comprehensive nutritional assessment, the adoption of screening tools, and the multidisciplinary, multimodality treatment approach to malnutrition in HIV/AIDS patients. Examples of creative and practical nutrition programs in HIV/AIDS care are presented because nurses often are in the position to act as change agents and develop clinical programs. The recognition and appreciation of the biopsychosocial consequences of malnutrition is at the crux of the matter for health care professionals. It is the step that propels us to embrace and value nursing interventions to support our patients 'nutritional status. Informing, coaching, teaching, reinforcing behaviors, strengthening social support, and modeling all are key activities of the nursing role that involves other professionals. Nutritional care should be approached as a continuous intervention to be addressed across all care settings and stages of health/illness. It is an inherent piece of all disease state management and wellness programs.

Nursing management of symptoms influenced by HIV infection of the endocrine system.

Examining the impact of endocrine disregulation is useful in managing symptoms of HIV infection in its later stages. Current studies indicate insults to the endocrine system from a variety of agents present in HIV infection. Establishing direct pathologic, causal effects is difficult; however, the functional domains of the endocrine system provide a good framework for nursing management of the symptoms of later-stage HIV infection.

Subjective global assessment in HIV-infected patients.

The Subjective Global Assessment (SGA) tool is utilized by multiple disciplines to determine the nutritional status of a patient. In this study, the SGA was revised for specific use with patients infected with HIV. The revised SGA was used with 36 HIV-infected patients (35 males, 1 female) in a clinic setting for assessment of nutritional status. The authors describe the results of each section of the SGA (weight changes, dietary intake, gastrointestinal symptoms, functional impairment, and physical examination). The most severely malnourished HIV-infected patients presented with a higher frequency of weight loss and gastrointestinal symptoms, a greater degree of functional impairment and wasting, and lower albumin and CD4 lymphocyte values. The revised SGA is useful in identifying which patients need referral to a registered dietitian for further nutritional intervention, education, and follow-up. Utilization of the SGA represents a key opportunity for nurses and dietitians to work collaboratively for the benefit of the patient.