HIV & AIDS
Lecturer: Dr. A. van Graan
Acknowledgements: Hilary Woodley
HIV & AIDS
Human immunodeficiency virus (HIV)
Acquired immunodeficiency syndrome
(AIDS)
Primary infection with HIV is the
underlying cause of AIDS
Incidence & Prevalence
WHO Report
Incidence & Prevalence
UN GLOBAL SUMMARY OF THE AIDS EPIDEMIC update: DECEMBER 2005
Incidence & Prevalence
Total:
40.3 million
(36.7-45.3)
UNAIDS/WHO
Incidence & Prevalence
Total:
4.9 million
(4.3-6.6)
UNAIDS/WHO
Incidence & Prevalence
Total:
3.1 million
(2.8-3.6)
UNAIDS/WHO
Incidence & Prevalence
UN GLOBAL SUMMARY OF THE AIDS EPIDEMIC update: DECEMBER 2005
Incidence & Prevalence
Sub-Saharan Africa has just over 10% of the
world’s population
more than 60% of all people living with HIV
2005, an estimated 3.2 million in the region
became newly infected
2.4 million adults and children died of AIDS
young people aged 15–24 years 4.6% of women
and 1.7% of men were living with HIV in 2005
WHO Report
Incidence & Prevalence
Incidence & Prevalence
UN GLOBAL SUMMARY OF THE AIDS EPIDEMIC update: DECEMBER 2005
Incidence & Prevalence
HIV prevalence among pregnant women:
highest levels to date: 29.5% (DOH in 2004)
women aged 25–34 years - more than 1 in 3
estimated HIV+
women aged 20–24 years - almost 1 in 3 was
infected
KwaZulu-Natal 40%
Eastern Cape, Free State, Gauteng, Mpumalanga
and North West provinces 27% - 31%
late teens (15–19 years) 15 - 16% since 2000
20–24 year-old 28% - 31% in 2000–2004
(Department of Health, 2005)
Incidence & Prevalence
UN GLOBAL SUMMARY OF THE AIDS EPIDEMIC update: DECEMBER 2005
Incidence & Prevalence
death registration data has shown that
deaths among people:
15 years of age and older increased by 62%
in 1997–2002
25–44 years more than doubling
nearly 2.9 million death notification
certificates more than 1/3 of all deaths were
among people in that age group
(Statistics SA, 2005)
HIV & AIDS
HIV invades the genetic core of the CD4+
or T-helper lymphocyte cells, the principal
agents involved in protection against
infection
HIV & AIDS
CD4+ cell count in blood is the common
laboratory test used
other distinct compartments contain virus
and evolve separately:
semen
vaginal secretions
the lymph system and
the central nervous system
HIV & AIDS
HIV infection causes a progressive
depletion of CD4+ cells, which eventually
leads to:
immunodeficiency
constitutional disease
neurologic complications
opportunistic infections and
neoplasms
HIV & AIDS
HIV can be transmitted via:
blood
semen
presemenal fluid
vaginal fluid
breast milk and
other body fluids that contain blood
HIV & AIDS
HIV can be transmitted via:
cerebrospinal fluid surrounding the brain and
spinal cord
synovial fluid surrounding bone joints and
amniotic fluid surrounding a foetus are other
fluids that can transmit HIV
HIV & AIDS
HIV can NOT be transmitted via:
saliva
tears and
urine
contact-touching
hugging or kissing
through using the same plates, silverware or
drinking glasses
HIV & AIDS
most common way HIV is transmitted is
via:
blood and semen during unprotected anal or
vaginal intercourse with an HIV-infected
person
risk of transmission through oral sex is
considered low but not risk-free
HIV & AIDS
Transmission can also occur by:
sharing of contaminated needles
injection of contaminated blood products
by transfer from an infected mother to her
baby before or during birth
through breast-feeding
HIV & AIDS
All persons should use universal
precautions to protect both themselves
and others when working with body fluids
HIV & AIDS
Two types of HIV:
HIV-1: Majority of HIV infection worldwide
HIV-2: West Africa
HIV-l mutates readily and has different
strains, which have many subtypes and
groups and are found distributed unevenly
throughout the world
HIV & AIDS
HIV-1 strains
• Group M (major) – prevalent – 90% of cases
• Group O (outlier) – rare and quite diverse
• Group N (new) – recently described in Cameroon
HIV-1 subtypes (clades) – A to J
• Initial epidemic in South Africa: B C
The reason for the genetic diversity is related
to inherent potential of virus to mutate
Manifestations & stages
After exposure and transmission of HIV
into the host
HIV spreads throughout the body and
blood CD4+ cell counts fall dramatically
Manifestations & stages
An immune response follows
CD4+ cells can return to almost normal
and
virus in the blood falls to an undetectable
level
Manifestations & stages
During this period of clinical latency
CD4+ cells de-crease to below a level at
which increased risks of opportunistic
infections occur
Untreated, HIV eventually replicates at
800 billion virus particles per day
Manifestations & stages
Both the World Health Organization and
the Centre’s for Disease Control have set
criteria for defining AIDS
The WHO staging is clinical and useful in
resource poor areas where laboratory
facilities are not always available
Manifestations & stages
WHO CDC
Clinical system Clinical + Lab
Stage 1 - 4 Stage A – C + 1 – 3
Includes functional Does not include
status functional status
Manifestations & stages
Krause 11th ED
Four stages of the disease have been
characterized:
(1) acute HIV infection
(2) asymptomatic chronic HIV infection
(3) symptomatic HIV infection
(4) AIDS or advanced HIV
Lymphadenopathy
www.aids-hiv.cz/ diagnostika.htm
Manifestations & stages
Krause 11th ED
Acute human immunodeficiency virus
(HIV) infection:
4- to 7 -week period immediately after
infection
viral replication is rapid
Manifestations & stages
Krause 11th ED
Acute human immunodeficiency virus (HIV) infection:
30 - 60% of newly infected persons develop an acute
syndrome with:
Fever
Malaise
Lymphadenopathy syndrome (LAS)
Pharyngitis
Headache
Myalgia and sometimes rash
which may last for a week to a month
Manifestations & stages
Krause 11th ED
Acute human immunodeficiency virus (HIV) infection:
The time period between the initial HIV infection and
seroconversion (the development of HIV antibodies)
varies from 1 week to several months or more
Once antibodies to HIV appear in the blood, individuals
with and without symptoms will test positive for HIV
Viral load is extremely high, and individuals are very
infectious at this time.
Manifestations & stages
Krause 11th ED
Asymptomatic HIV stage:
few, if any, noticeable symptoms occur
last from a few months to as long as 10 years
Subclinical changes have been reported:
decrease in lean body mass without apparent total
body weight change
vitamin B12 deficiency and
increased susceptibility to food borne and
waterborne pathogens
Manifestations & stages
Krause 11th ED
Symptomatic HIV occurs when symptoms appear
(CDC Category B)
symptoms may include:
fevers
sweats
skin problems
fatigue or
other symptoms that are not AIDS-defining
a decline in nutrient status or body composition
may also occur
Manifestations & stages
Krause 11th ED
AIDS, or advanced HIV disease:
the diagnostic term reserved for those
persons with at least one well-defined,
life-threatening clinical condition that is
clearly linked to HIV-induced
immunosuppression (CDC Category C)
Manifestations
& stages
CD4 cell
counts and
associated
conditions
Krause 11th Ed,
Table 41.1
Manifestations
& stages
CD4 cell
counts and
associated
conditions
Krause 11th Ed,
Table 41.1
Manifestations
& stages
Categories for
Children
Krause 11th Ed,
Table 41.2
CDC 1993 Clinical categories
A B C
CD4+ cell Asympt. Symptomatic
(not A or C) Aids indicator
count or diseases
categories
PGL
1
> 500/mm3 A1 B1 C1
2
200–499/mm3 A2 B2 C2
3
< 200/mm3 A3 B3 C3
Manifestations
& stages
CDC 1993
Krause 11th Ed,
Box 41.1
Opportunistic Infections and Other
Complications
Opportunistic infections with:
bacteria
fungi
protozoa or
viruses
are common in this population
Opportunistic Infections and Other
Complications
They are often cause:
diarrhoea
malabsorption
fever and
weight loss
as well as many other symptoms
Opportunistic Infections and Other
Complications
Malignant Disease
Kaposi's sarcoma (KS) is a malignant disease of
the peripheral blood mononuclear cells that
manifests as purple nodules on the:
skin
mucous membranes
lymph nodes
gastrointestinal tract
www.thachers.org/ images/Kaposi2.jpg
Opportunistic Infections and Other
Complications
Malignant Disease
KS lesions in the oral cavity or
oesophagus may cause:
pain and difficulty with chewing and
swallowing
KS lesions in the intestinal tract have been
implicated in:
diarrhoea and intestinal obstruction
Opportunistic Infections and Other
Complications
Malignant Disease
Lymphomas include:
non-Hodgkin's lymphoma and Burkitt's
lymphoma that involve the small bowel
can cause:
malabsorption
diarrhoea
intestinal obstruction
Opportunistic Infections and Other
Complications
Malignant Disease
Lymphomas include:
Primary lymphoma in the brain can cause
alterations in:
personality
motor and cognitive abilities
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Immediately following infection, HIV enters
the brain and may result in:
HIV encephalopathy (AIDS dementia)
myelopathy
peripheral neuropathy and
myopathy
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Secondary neurologic complications may result
from:
toxoplasma encephalitis
progressive multifocal leukoencephalopathy
cytomegalovirus (CMV) encephalitis
radiculomyelitis
cryptococcal eningitis
primary central nervous system lymthoma
neurosyphilis
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Before there were medications to control
viral replication, dementia affected 25% of
those living with HIV
today the rate of HIV-associated dementia
is below 10%
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Symptoms of AIDS dementia may include
deterioration in:
cognition (concentration, recall, new memory
development, language)
motor function (coordination, gait, bladder control)
behaviour (psychosis, depression, withdrawal)
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Viral load in the brain and the level of
neurologic decline are not strongly
correlated
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Myelopathy (disease of the spinal cord) may
occur in as many as 25% of those with
advanced HIV disease and can result in partial
paralysis of the lower extremities (paraparesis)
Myelopathy affects motor and sensory functions
and is manifested by:
spasticity
weakness in the legs and
bladder
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Myopathy – (progressive muscle weakness) is
usually a result of:
HIV infection or
toxicity from AZT (If AZT is the underlying
cause, creatine kinase levels are usually
elevated)
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Approximately 20% of patients with AIDS
experience peripheral neuropathy, which is
characterized by:
sensory loss
pain
weakness
wasting of muscle in the hands or legs and feet
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
The first signs of peripheral neuropathy
are:
tingling
burning
numbness
in the toes and fingers
Opportunistic Infections and Other
Complications
Neuromuscular Diseases
Peripheral neuropathy may be caused by:
the virus or
drugs (zalcitabine, didanosine, and
stavudine)
Opportunistic Infections and Other
Complications
HIV-Liver Disease
Hepatitis C (HVC) is now considered an
HIV opportunistic infection
Those with both HIV and HVC have a
faster progression to AIDS and death
current HVC treatments do not seem to
alter outcome in HIV-infected persons
Opportunistic Infections and Other
Complications
HIV-Liver Disease
Liver function may be compromised by:
the use of highly active antiretroviral therapy
infection with cytomegalovirus (CMV)
cryptosporidia
hepatitis B
by hepatic malignant diseases, such as KS or
lymphoma
Opportunistic Infections and Other
Complications
Tuberculosis and Lung Diseases
most cases of tuberculosis (TB) affect the lungs
in HIV-infected persons may also occur in
extrapulmonary sites such as the:
larynx
lymph nodes
brain
kidneys
bones
Opportunistic Infections and Other
Complications
Tuberculosis and Lung Diseases
Medical conditions that increase the risk of TB
infection include:
HIV infection
a body weight that is 10% or more below ideal weight
immunosuppressive therapy
hematologic disorders such as leukemia and
lymphomas
Opportunistic Infections and Other
Complications
HIV-Associated Nephropathy
HIV associated nephropathy (HIVAN), a syndrome of
progressive renal failure may occur
Proteinuria may also result from:
repeated infections
volume depletion
nephrotoxic drugs
Acute renal failure
Deaths from kidney disease have increased
Dosing of drugs and nutrition therapy must be adjusted
for those with renal failure
Opportunistic Infections and Other
Complications
Other Affected Organ Systems
Chronic diarrhoea in the absence of identifiable
enteric pathogens due to AIDS enteropathy
HIV enteropathy may have villous atrophy and
abnormal results on tests of small bowel function
Because of the vulnerability of persons with
immune suppression to foodborne and
waterborne pathogens, food and water safety is
a concern
Opportunistic Infections and Other
Complications
Other Affected Organ Systems
Intestinal injury is related to specific
complications rather than to the
immunodeficiency
Food safety …
HIV / AIDS:
Campylobacter
(AIDS 35x more frequently)
Listeria and
(AIDS 100x more frequently)
Salmonella
(AIDS more common see egg guidelines)
Egg cooking guidelines
yolk and white are firm, not runny
Scrambled -1 minute at medium stove top setting (250
deg F for electric frying pans)
Sunnyside -7 minutes at medium setting (250 deg F) or
cook covered 4 minutes at 250 deg F
Fried, over easy -3 minutes at medium setting (250 deg
F) on one side, then turn and fry for another minute on
the other side
Poached -5 minutes in boiling water
Boiled -7 minutes in boiling water
http://vm.cfsan.fda.gov/~dms/aidseat.html
Medical management
Highly active antiretroviral therapy (HAART)
a combination of at least 3 anti-retroviral
agents (ART) used to suppress:
viral replication
progression of HIV disease
ART DOES NOT ERADICATE HIV
Medical management
Highly active antiretroviral therapy (HAART)
3 drug classes include:
NRTIs = Nucleoside reverse transcriptase
inhibitors
NNRTIs = Non-nucleoside reverse
transcriptase inhibitors
PIs = Protease inhibitors
Medical management
NRTIs – inhibit virus replication by directly
blocking chain extention during reverse
transcription using nucleoside analogues as
chain terminators
NNRTIs - inhibit virus replication by binding
directly to the reverse transcriptase and
preventing reverse transcription
Medical management
NRTIs
NNRTIs
PIs inhibit formation of
mature infectious virus
particles by blocking
protease activity and
thereby preventing
cleavage of the gag-pol
polyprotein
Medical management
Highly active antiretroviral therapy (HAART)
use of only one antiretroviral drug has
been recognized as leading to drug
resistant mutants of the virus
Medical management
HAART Therapy considers:
1. Viral Load Levels (HIV-RNA) which predict the risk of
HIV disease progression, and when to initiate or change
therapy
2. Current and lowest CD4+ counts for the extent of HIV-
induced immune damage and the risk for opportunistic
infections
3. Current and past clinical conditions and symptoms of
HIV disease, including history of treatment outcomes
4. Life stage: children, adolescents and pregnant women
warrant special considerations
Medical management
Concerns about HAART that need to be
considered in developing nutritional
plans include the following:
Viral resistance can occur
Medical management
Concerns about HAART that need to be
considered in developing nutritional plans
include the following:
Patients must adhere to daily-and often
very complicated-drug schedules, which
may have bothersome meal and food
requirements
(NB see Krause 11th ED Table 41-5)
Medical management
Concerns about HAART …
One must be more than 95% adherent for
medications to work correctly. Late, missed, or
non-meal-coordinated medications increase
risks for:
suboptimal dosing
viral breakthrough
the development of drug-resistant strains of HIV
Medical management
Concerns about HAART that need to be
considered in developing nutritional
plans include the following:
Not all patients tolerate antiretroviral
drugs.
Medical management
Concerns about HAART that need to be
considered in developing nutritional plans
include the following:
New adverse complications have emerged:
body fat accumulation and fat atrophy
Hyperlipidemia
insulin resistance or glucose intolerance
osteopenia and osteoporosis
avascular necrosis
bone fracture
lactic acidosis
mitochondrial toxicity
Regional fat accumulation
Aboulafia and Bundow 1998 Carr and Cooper 1998 aidsmyth.addr.com
Facial waisting
www.emedicine.com/derm/topic877.htm
Medical management
Concerns about HAART that need to be
considered in developing nutritional plans
include the following:
The loosely termed lipodystrophy syndrome
stems from one or more of the following causes:
drug side effects
extended exposure to the virus or activated immune
cells characteristic of HIV infection
immune system alterations along with suppression of
the virus by the drugs
Medical management
Concerns about HAART that need to be
considered in developing nutritional plans
include the following:
Medication costs
Medical management
Medical management
NB see Krause 11th ED Table 41-5
Medical management
Ingestion
Both drugs and disease can cause
changes in:
appetite and
nutrient intake
resultant malnutrition can affect drug
efficacy
Medical management
Absorption
Drugs and foods can have mechanical effect, via
binding or adsorption that can influence the
absorptive processes resulting in ↑ or ↓ drug and
nutrient absorption.
Some drugs can affect gastrointestinal motility
thereby ↑ or ↓ absorption of nutrients.
Chemical factors, in particular pH of the stomach
contents and the influence of foods therein, can
affect the subsequent absorption of drugs.
Medical management
Transluminal transport
The ability of drugs and nutrients to be
transported can depend on such factors
as:
lipid solubility and
competition for amino acid transport
systems
Medical management
Metabolism
The effectiveness of the mixed function
oxidase (MFO) and conjugase systems in
the liver and elsewhere for converting
drugs and nutrients into their active and,
ultimately, excretory forms depends on the
availability of specific nutrient cofactors.
Medical management
Metabolism
In addition, certain drugs can increase the
activity of the MFO systems required to
convert nutrient precursors into their active
forms. Nonnutritive components in foods
can induce MFO activity, thereby affecting
drug metabolism.
Medical management
Distribution
The utilization of both drugs and nutrients
depends on body composition, the
availability and functional integrity of
transport proteins, receptor integrity and
intracellular metabolic machinery
Medical management
Elimination
Drugs and nutrients can synergistically
and competitively interact to cause
increased or decreased excretion.
Systemic factors such pH and
physiological state (e.g., sweating) can
dictate whether a drug or nutrient is
excreted or resorbed.
In conclusion on ART
An intimate link exists between pharmacology
and nutrition that is affected by stage of
development and physiological differences (i.e.,
gender, physiological state)
In areas were malnutrition and HIV infection
coexist, it will be essential to incorporate a full
appreciation of the important role of diet and
nutrition in the implementation of those
strategies designed to prevent and treat
HIV/AIDS in adults, infants and children
In conclusion on ART
Documentation is needed of dietary
supplement use including use of herbal
and botanical therapies (that can
potentially cause drug/supplement
interactions which in turn affect the
efficacy, safety and/or compliance with
ART)
Malnutrition and HIV & AIDS
complex interactions between nutrition and
HIV/AIDS
HIV progressively weakens the immune
system and
malnutrition itself may also increase the
susceptibility to infections
Malnutrition and HIV & AIDS
Oxford Handbook of HIV medicine
Malnutrition and HIV & AIDS
HIV infection co-exists with:
macronutrient malnutrition - protein-energy
malnutrition (PEM) and
hidden hunger of micronutrient
deficiencies
Nutrient requirements
Weight loss in adults and growth failure in
children are common in HIV/AIDS infected
children and adults
www.usnews.com/usnews/
photography/aids/aids1.htm
Nutrient requirements
Energy
requirements are likely to increase by 10% to
maintain body weight and physical activity in
asymptomatic HIV-infected adults
An additional 20–30% increase in energy needs
occurs during the convalescent catch-up period
after a severe infection
During symptomatic HIV, and subsequently
during AIDS, energy requirements increase by
approximately 20% to 30% to maintain adult
body weight
WHO 2004
Nutrient requirements
Energy
These targets should be achieved through
food-based approaches whenever
possible
Pregnant and lactating requirements the
same as non HIV infected women
Nutrient requirements
Energy
Normal energy requirements:
30-35 kCal/kg/day
Malnourished:
40-45 kCal/kg/day
Nicus fact sheet, 2002
Nutrient requirements
Protein
Loss of body protein during HIV/AIDS is
therefore caused by:
poor diet
malabsorption
endogenous intestinal losses and
altered metabolism
all are more striking during opportunistic infection
Nutrient requirements
Protein
no evidence for increased protein
requirement over and above that required
in a balanced diet to satisfy the total
energy requirements
12 to 15% of the total energy intake
Nutrient requirements
Fat
no evidence that fat requirements are
different because of HIV infection
Nutrient requirements
Micronutrients
To ensure micronutrient intakes at RDA
levels, HIV-infected adults and children
are encouraged to consume healthy diets
Nutrient requirements
Micronutrients
A synergistic relationship exists when a
specific micronutrient deficiency increases
infectious disease morbidity
in which case either improved
micronutrient intake or treatment of the
infection will break the vicious circle
Nutrient requirements
Micronutrients
But an antagonistic relationship can also
exist when a specific micronutrient
deficiency reduces - or increased intake
increases - infectious disease morbidity
Nutrient requirements
Micronutrients
Then some micronutrients may act
synergistically in moderate doses but
antagonistically in high doses
Example, zinc, although essential to the
immune system is immunosuppressive in
high doses
Nutrient requirements
Micronutrients
dietary intake of micronutrients at RDA
levels may not be sufficient to correct
nutritional deficiencies in HIV-infected
individuals
Nutrient requirements
Micronutrients
BUT there is evidence that some
micronutrient supplements, e.g. vitamin A,
zinc and iron, can produce adverse
outcomes in HIV-infected populations
Nutrient requirements
WHO Micronutrients and HIV infection: a review of current evidence April 2005
Nutrient requirements
WHO Micronutrients and HIV infection: a review of current evidence April 2005
Nutrient requirements
Vitamin A
the importance of vitamin A to immune
functions and childhood infections and
mortality, it is plausible that vitamin A is
beneficial in HIV infection
However, in vitro studies in different cell
lines suggest that vitamin A may both
reduce and increase viral replication
Nutrient requirements
Vitamins B, C and E
Several of the B vitamins as well as
vitamins C and E have been associated
with reduced risk of HIV progression in
observational studies
Nutrient requirements
Iron
Iron deserves special mention because
both the effect of HIV infection on status
and the effect of status and intake on HIV
infection seem to be different from those of
other micronutrients
Nutrient requirements
Iron
Iron may have adverse effects in HIV and
other viral infections data suggest that iron
may increase the susceptibility to and
severity from common and opportunistic
infections, such as tuberculosis
Nutrient requirements
Iron
Iron may have adverse effects in HIV and
other viral infections data suggest that iron
may increase the susceptibility to and
severity from common and opportunistic
infections, such as tuberculosis
Nutrient requirements
Zinc
Zinc is a component of both structural and
catalytic proteins of HIV
Zinc is required for the activity of reverse
transcriptase and the production of
infectious virus and may inhibit HIV
replication through binding to the catalytic
site of HIV protease
Nutrient requirements
Zinc
The association between zinc intake and
increased progression to AIDS and death, found
in one cohort study in U.S. patients with a high
intake of highly bioavailable zinc but not in
another, may have delayed assessment of the
effect of zinc supplementation in populations at
risk of zinc deficiency
Nutrient requirements
Zinc
Given the considerable importance of zinc for
immune functions and in the prevention of
diarrhoea and respiratory tract infections, it is
likely to play a role in HIV infection
A RCTs in adults with pulmonary TB co-infected
with HIV found no significant effect of 45 mg of
zinc daily during TB treatment on viral load
In fact, zinc in combination with other
micronutrients considerably increased weight
gain and seemed to increase survival during
treatment
Nutrient requirements
Selenium
despite the finding from several
observational studies that low serum
selenium is strongly associated with HIV
progression, there are no reports of the
effect of selenium supplementation on viral
load or clinical HIV endpoints although
reduced hospitalization rate was reported
Nutrient requirements
Micronutrients and Pregnancy
To prevent anaemia, WHO recommends daily
iron-folate supplementation (400 μg of folate and
60 mg of iron) during six months of pregnancy,
and to treat severe anaemia twice-daily
supplements
Available data do not support a change in this
recommendation for women living with HIV
Nutrient requirements
Micronutrients and Pregnancy
Daily vitamin A intake by HIV-infected women during
pregnancy and lactation should not exceed the RDA
In areas of endemic vitamin A deficiency, WHO
recommends that a single high-dose of vitamin A (200
000 IU) be given to women as soon as possible after
delivery, but no later than six weeks after delivery
Research is under way to assess further the effect of
singledose, postpartum vitamin A supplementation
among HIV-infected women
Nutrient requirements
In conclusion
Use of a multivitamin supplement not
exceeding more than 2x the RDA (200%)
Nutrient requirements
Fluid requirements
Same as for healthy individuals
30-35ml/kg/day
Compensate for:
Diarrhea (electrolyte replacement NB)
Nausea
Vomiting (electrolyte replacement NB)
Night sweats
Prolonged fever
Nutrient requirements
NB Practical eating suggestions for
symptom management
Box 41.4 Krause 11th Ed pg 1050
South African National Guidelines on
Nutrition for People living with TB,
HIV/AIDS and other chronic debilitating
conditions www.sun.ac.za/nicus
What to do if … notes
Nutrient requirements
NB Nutrition intervention for diarrhea
Table 41.7 Krause 11th Ed pg 1052
NB Food safety
South African National Guidelines on
Nutrition for People living with TB,
HIV/AIDS and other chronic debilitating
conditions www.sun.ac.za/nicus
HIV & AIDS
Websites used for complilation of slides:
www.unaids.org
www.sun.ac.za/nicus
www.who.int
HIV & AIDS
For further information on the following South African
Department of Health articles
HIV/AIDS related
Guidelines for the management of HIV-infected children - 2005
Monitoring and Evaluation of the Operational Plan for
Comprehensive HIV and AIDS Care, management and Treatment
for South Africa
- Training Manual for Facilitators - April 2005
- Training Manual for Participants - April 2005
National Antiretroviral Treatment Guidelines - 2004
Circular Minute on Prevention of Mother-To-Child Transmission of
HIV - 16 April 2002
Visit http://www.doh.gov.za/docs/facts-f.html
Oral Candidiasis
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Oral Candidiasis
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Oesophageal Candidiasis
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Oral Hairy
Leukoplakia
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Clinical picture – Oral KS
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Disseminated herpes
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA
Herpes Zoster
Dr Emille Reid, Senior Specialist Physician: Internal Medicine & Infectious Diseases, UKWANDA