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cancer and HIV

answer

both disorders have debilitating effects that influence nutritional needs, and both can lead to severe wasting in advanced cases

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cancer

answer

diseases characterized by the uncontrolled growth of abnormal cells, which can destroy adjacent tissues and spread to other areas of the body via lymph or blood. - the different types of cancer have different characteristics, occur in different locations in the body, take different courses, and require different treatments.

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human immunodeficiency virus (HIV)

answer

the virus that causes acquired immune deficiency syndrome (AIDS). HIV destroys immune cells and progressively impedes the body's ability to fight infections and certain cancers.

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growth of malignant tissue

answer

second most common cause of death in the United States, ranking just below cardiovascular disease

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malignant

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describes a cancerous cell or tumor, which can injure healthy tissue and spread cancer to other regions of the body

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isolated, non spreading skin cancer

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removed in a physician's office with no effect on nutrition status, advanced cancers—especially those of the gastrointestinal (GI) tract and pancreas—can seriously impair nutrition status.

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most common cancers in U.S

answer

breast cancer (in women), prostate (in men), lung cancer, and colorectal cancers

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carciogensis

answer

the process of cancer development. -often proceeds slowly and continues for several decades

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cancer arises

answer

from genetic mutations or altered expressions of genes that regulate cell devision in a single cell - promote cellular growth, interfere with growth restraint, or prevent cellular death.

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affected cell

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loses its built-in capacity for halting cell division and produces daughter cells with the same genetic defects

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tumor

answer

an abnormal tissue mass that has no physiological function; also called a neoplasm - as it grows a network of blood vessels forms to supply the tumor with the nutrients it needs to support its growth

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metastasize

answer

spread from one part of the body to another; refers to cancer cells.

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leukemia

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- cancer affecting the white blood cells - the abnormal cells do not form a tumor; they accumulate in the blood and other tissues.

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vulnerability to cancer

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sometimes inherited, as when a person is born with a genetic defect that alters DNA structure, function, or repair

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metabolic proccesses

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- may initiate carcinogenesis, as when chronic inflammation increases the rate of cell division and the risk of a damaging mutation

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causes of cancer

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interactions between a person's genes and the enviornment

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carcinogens

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substances that can cause cancer -may induce genetic mutations that lead to cancer

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influences cancer

answer

environmental factors, diet, and lifestyle

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food components

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- can alter processes of DNA repair, gene expression, or cell differentiation in the ways that affect cancer development - directly damage DNA, alter the metabolism of carcinogens by liver enzymes, or inhibit carcinogen formation in the body

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energy balance and growth rates

answer

may influence cancer risk by modifying rates of cell division (and therefore, the risks of damaging mutations) as well as levels of hormones that regulate cell growth.

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obesity

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- risk factor for a number of different cancers - examples: colon cancer and postmenopausal breast cancer. - increases cancer risk, in part, by altering levels of hormones that influence cell growth, such as the sex hormones, insulin, and several types of growth factors.

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breast cancer in postmenopausal women

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- hormone estrogen is likely involved: obese women have higher estrogen levels than lean women do because adipose tissue is the primary source of estrogen after menopause - increase in circulating estrogen may create an environment that encourages carcinogenesis in breast tissue

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alcohol consumption

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correlates strongly with cancers of the head and neck, colon, rectum, and breast

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head and neck cancers

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the risk is multiplied when alcohol drinkers also smoke tobacco

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alcohol abuse

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- may damage liver and instigate the development of liver cancer - why the potential benefits of moderate alcohol consumption on CVD risk must be weighed against the potential dangers

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food prep methods

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responsible for producing certain types of carcinogens - cooking meat, poultry, and fish at high temperatures (by frying or broiling, for example) causes carcinogens to form in these foods

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carcinogens in smoke

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- accompany the smoke that adheres to food during grilling, and they are present in the charred surfaces of grilled meat and fish

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nutrition and decreased cancer risk

answer

- consumption of fruits and vegetables may provide some benefits in protecting against the development of cancer

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fruits and vegetables

answer

contain both nutrients and phytochemicals with antioxidant activity, and these substances may prevent or reduce the oxidative reactions in cells that cause DNA damage - contribute dietary fiber, which may help to protect against colon and rectal cancers by diluting potential carcinogens in fecal matter and accelerating their removal from the GI tract

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phytochemicals

answer

help to inhibit carcinogen production in the body, enhance immune responses that protect against cancer development, or promote enzyme reactions that inactivate carcinogens

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B vitamin folate

answer

provided by certain fruits and vegetables, plays roles in DNA synthesis and repair; thus, inadequate folate intakes may allow DNA damage to accumulate

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consequences of cancer

answer

- depend on the location of the cancer, its severity, and the treatment

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complications of cancer that develop

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often due to a tumor's impingement on surrounding tissues

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nonspecific effects of cancer

answer

anorexia, malaise, weight loss, night sweats, and fever

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early stages of cancer

answer

produce no symptoms, and person is unaware of the threat to health

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cancer cachexia

answer

a wasting syndrome associated with cancer that is characterized by anorexia, muscle wasting, weight loss, and fatigue - develops in up to 50% of cancer patients - directly responsible for as many as 20% of cancer deaths

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without adequate energy and nutrients

answer

body is poorly equipped to maintain organ function, support immune defenses, and mend damaged tissues

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involuntary weight loss

answer

of more than 10%, which indicates significant malnutrition, is a cause for concern

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cytokines

answer

released by both tumor cells and immune cells, induce an inflammatory and catabolic state.

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combined effects of a poor appetite, accelerated and abnormal metabolism, and the diversion of nutrients to support tumor growth

answer

result in a lower supply of energy and nutrients at a time when demands are high

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appetite and food intake

answer

further disturbed by the effects of treatments and medications prescribed for cancer patients. Unlike in starvation, nutrition intervention alone is unable to reverse cachexia

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metabolic changes

answer

- metabolic changes that arise in cancer exacerbate the wasting -Triglyceride breakdown increases, elevating serum lipids. - Many patients develop insulin resistance. - these metabolic abnormalities help to explain why people with cancer fail to regain lean tissue or maintain healthy body weights even when they are consuming adequate energy and nutrients

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protein

answer

- cancer patients exhibit an increased rate of protein turnover, but reduced muscle protein synthesis - muscle contributes amino acids for glucose production, further depleting the body's supply of protein

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anorexia

answer

major contributor to the wasting associated with cancer

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factors that contribute to anorexia or reduce food intake

answer

chronic nausea and early satiety, fatigue, pain, mental stress, gastrointestinal obstructions, effects of cancer therapies

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chronic nausea and early satiety

answer

people with cancer frequently experience nausea and a premature feeling of fullness a er eating small amounts of food

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fatigues

answer

People with cancer may tire easily and lack the energy to prepare and eat meals. Once cachexia develops, these tasks become even more difficult.

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pain

answer

People in pain may have little interest in eating, particularly if eating makes the pain worse.

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mental stress

answer

A cancer diagnosis can cause distress, anxiety, and depression, all of which may reduce appetite. Facing and undergoing cancer treatments induce additional psychological stress.

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gastrointestinal obstructions

answer

A tumor may partially or completely obstruct a portion of the GI tract, causing complications such as nausea and vomiting, early satiety, delayed gastric emptying, and bacterial overgrowth. Some patients with obstructions are unable to tolerate oral diets.

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effects of cancer therapies

answer

Chemotherapy and radiation treatments for cancer frequently have side effects that make food consumption difficult, such as nausea, vomiting, dry mouth, altered taste perceptions, food aversions, mouth sores, inflammation of the mouth and esophagus, difficulty swallowing, abdominal pain or discomfort, diarrhea, and constipation

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primary medical treatments for cancer

answer

surgery, chemotherapy, radiation therapy, or any combination of the three—aim to remove cancer cells, prevent further tumor growth, and alleviate symptoms

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likelihood of effective treatment

answer

highest with early detection and intervention

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health care providers

answer

treatment decisions are difficult and cancer therapies have considerable side effects, patients rely on health care providers to help them make informed decisions

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surgery

answer

- performed to remove tumors, determine the extent of cancer, and protect nearby tissues - Often, surgery must be followed by other cancer treatments to prevent the growth of new tumors - acute metabolic stress caused by surgery raises protein and energy needs and can exacerbate wasting. - Surgery also contributes to pain, fatigue, and anorexia, all of which can reduce food intake at a time when nutritional needs are substantial - can have long term effects on nutrition status

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chemotherapy

answer

the use of drugs to arrest or destroy cancer cells; these drugs are called antineoplastic agents - Some cancer drugs interfere with the process of cell division; others sterilize cells that are in a resting phase and are not actively dividing. - Unfortunately, most of these drugs have toxic effects on normal cells as well and are especially damaging to rapidly dividing cells, such as those of the GI tract, skin, and bone marrow.

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bone marrow damage

answer

suppress the production of red blood cells (causing anemia) and white blood cells (neutropenia)

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neutropenia

answer

a low white blood cell (neutrophil) count, which increases susceptibility to infection

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radiation therapy

answer

- the use of X-rays, gamma rays, or atomic particles to destroy cancer cells -generate reactive forms of oxygen, such as superoxide and hydroxyl radicals, which can damage cellular DNA and cause cell death. - Newer techniques are able to focus radiation directly at tumors and minimize damage to nearby tissues - radiation therapy can damage healthy tissues and sometimes has long-term detrimental effects on nutrition status

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advantages of radiation therapy over surgery

answer

can shrink tumors while preserving organ structure and function

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radiation therapy compared to chemotherapy

answer

radiation therapy is better able to target specific regions of the body, rather than involving all body cells

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radiation to the head and neck area

answer

can damage the salivary glands and taste buds, causing in ammation, dry mouth, and a reduced sense of taste; in severe cases, damage may be permanent

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radiation entertis

answer

inflammation of intestinal tissue caused by radiation therapy - effect of radiation treatment in the lower abdominal area - causes nausea, vomiting, malabsorption, and diarrhea - the condition may persist for months or years and lead to chronic malabsorption in some individuals

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hematopoietic stem cell transplantation

answer

transplantation of the stem cells that produce red blood cells and white blood cells; the stem cells are obtained from the bone marrow ( bone marrow transplantation) or circulating blood. - these procedures may be used to treat leukemias, lymphomas, and multiple myeloma - If possible, the stem cells are collected from the patient's bone marrow or circulating blood before chemotherapy or radiation treatment begins so that it is not necessary to find a separate donor. - If another person's cells are used, the patient must take immunosuppressant drugs to prevent tissue rejection

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tissue rejection

answer

destruction of donor tissue by the recipient's immune system, which recognizes the donor cells as foreign

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biological therapies

answer

- Newer therapies for cancer include the use of biological molecules that stimulate immune responses against cancer cells (also called immunotherapy). - these substances include antibodies, cytokines, and other proteins that strengthen the body's immune defenses, enable the destruction of cancer cells, or interfere with cancer development in some way. - Although side effects vary, many of these treatments can cause anorexia, GI symptoms, and general discomfort, reducing a person's ability or desire to consume adequate amounts of food

question

medications prescribed to stimulate the appetite and promote weight gain

answer

-megestrol acetate (Megace): synthetic compound similar in structure to the hormone progesterone -dronabinol (Marinol): resembles the psychoactive ingredient in marijuana and stimulates the appetite at doses that have minimal mental effects

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antiemetic drugs

answer

control nausea and vomiting, are typically coadministered with chemotherapeutic drugs to improve appetite and food intake

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complementary and alternative medicine (CAM)

answer

- assist them in their fight against cancer - patients may use CAM because they wish to have more control over their treatments or because they are concerned about the effectiveness of conventional approaches. - Although few abandon conventional medicine, up to 80% of cancer patients combine one or more CAM approaches with standard treatment.

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multivitamin and herbal supplements

answer

among the most frequently used CAM therapies. Although many supplements can be used without risk, some may have adverse effects or interfere with conventional treatments

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use of the herb St. John's wort

answer

can reduce the effectiveness of some anticancer drugs

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Most research suggests that the use of dietary supplements (including multivitamin supplements)

answer

is unable to improve outcomes or survival a er a cancer diagnosis and may actually increase mortality rates.

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nutrition therapy for cancer

answer

- the goals of nutrition therapy for cancer patients are to maintain a healthy weight, preserve muscle tissue, prevent or correct nutrient deficiencies, and provide a diet that patients can tolerate and enjoy despite the complications of illness - person's needs may change at different stages of illness - patients should be screened for malnutrition when cancer is diagnosed and be reassessed during the treatment and recovery periods

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appropriate nutrition care

answer

helps patients preserve their strength and improves recovery after stressful cancer treatments

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malnourished cancer patients

answer

develop more complications and have shorter survival times than patients who maintain good nutrition status.

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For patients at risk of weight loss and wasting

answer

the focus of nutrition care is to ensure appropriate intakes of protein and energy

question

protein requirements

answer

often between 1.0 and 1.6 grams per kilogram of body weight daily

question

energy needs

answer

may range from 25 to 35 kcalories per kilogram of body weight per day for most patients, with higher amounts recommended for patients with severe stress, hypermetabolism, and various other complications

question

nutrient-dense oral supplements

answer

Patients who cannot eat adequate food may be able to meet their needs by supplementing the diet with nutrient dense oral supplements

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gain weight

answer

- Although weight loss is a problem for many cancer patients, breast cancer patients often gain weight - weight gain occurs during the first two years after breast cancer diagnosis and is associated with an increase in total body fat. - By discussing weight maintenance soon after diagnosis and encouraging physical activity, health practitioners can help patients avoid unnecessary weight gain

question

thorough nutrient assessment

answer

often uncovers specific problems or symptoms that interfere with food consumption

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low microbial diet

answer

a diet that contains foods that are unlikely to be contaminated with bacteria and other microbes -patients with suppressed immunity or neutropenia may be prescribed -patients should consume only well-cooked meats and eggs, pasteurized milk products, well-washed fruits and vegetables, and shelf-stable packaged foods

question

foods that should be avoided

answer

unwashed raw fruits and vegetables; unpasteurized juices and milk products; undercooked meat, poultry, and eggs; left over luncheon meats and meat spreads; left over foods that have not been adequately reheated; and foods from salad bars or street vendors - follow safe food handling practices

question

Tube feedings or parenteral nutrition

answer

may be needed by patients who have long-term or permanent gastrointestinal impairment or are experiencing complications that interfere with food intake

question

patients undergoing radiation therapy for head and neck cancers

answer

have dysphagia and require long-term tube feeding

question

Parenteral nutrition

answer

is reserved for patients who have inadequate GI function, such as those with severe radiation enteritis

question

enteral nutrition

answer

is strongly preferred over parenteral nutrition, to preserve GI function and avoid infection

question

acquired immune deficiency syndrome (AIDS)

answer

the late stage of illness caused by infection with the human immunodeficiency virus (HIV); characterized by severe damage to immune function. - In the 30-plus years since AIDS has been identified, it has caused over 25 million deaths worldwide - Access to antiretroviral drugs continues to increase throughout the world, reducing AIDS-related deaths and the risk of HIV transmission.

question

Africa

answer

Although the global incidence of HIV infection has been declining in recent years, its prevalence continues to be high in sub-Saharan Africa, where it affects 5% of the adult population

question

HIV infection

answer

- HIV is most often sexually transmitted and can be spread by direct contact with contaminated body fluids, such as blood, semen, vaginal secretions, and breast milk. - Because many people remain symptom-free during the early stages of infection, they may not realize that they can pass the infection to others. - To reduce the spread of HIV infection, individuals at risk are encouraged to undergo testing. - A blood test can usually detect HIV antibodies within several months after exposure and, often, after two or three weeks. - An estimated 21% of persons in the United States who have HIV infection are unaware that they are infected.

question

consequences of HIV infection

answer

HIV infection destroys immune cells that have a protein called CD4 on their surfaces.

question

helper T cells

answer

lymphocytes that have a specific protein called CD4 on their surfaces and therefore are also known as these are the cells most affected in HIV infection. -HIV is able to enter the helper T cells and induce them to produce additional copies of the virus, thus perpetuating and exacerbating the infection

question

Other cells that have the CD4 protein (and are infected by HIV)

answer

include tissue macrophages and certain cells of the central nervous system

question

Early symptoms of HIV infection

answer

are nonspecific and may include fever, sore throat, malaise, swollen lymph nodes, skin rashes, muscle and joint pain, and diarrhea. - After these symptoms subside, many people remain symptom-free for 5 to 10 years or even longer.

question

If the HIV infection is not treated

answer

the depletion of T cells eventually increases the person's susceptibility to opportunistic infections

question

opportunistic infections

answer

infections from microorganisms that normally do not cause disease in healthy people but are damaging to persons with compromised immune function

question

AIDS-defining illnesses

answer

diseases and complications associated with the later stages of an HIV infection, including wasting, recurrent bacterial pneumonia, opportunistic infections, and certain cancers.

question

Without treatment for AIDS

answer

develops in 26-36% of HIV-infected persons within 7 years

question

Health practitioners

answer

evaluate disease progression by measuring the concentrations of helper T cells and circulating virus (called the viral load) and by monitoring clinical symptoms.

question

Although current drug therapies dramatically slow the progression of HIV infection

answer

the drugs' side effects may make it difficult for patients to adhere to treatments, as discussed in several of the following sections

question

lipodystrophy

answer

abnormalities in body fat and fat metabolism that may result from drug treatments for HIV infection. The accumulation of abdominal fat is sometimes called protease paunch -Patients may lose fat from the face and extremities, accumulate abdominal fat, or both. - Also observed are breast enlargement (in both men and women), fat accumulation at the base of the neck, and benign growths composed of fat tissue - changes in body composition are often disfiguring and may cause physical discomfort; moreover, patients often develop hypertriglyceridemia, elevated low-density lipoprotein (LDL) cholesterol levels, reduced high-density lipo- protein (HDL) cholesterol levels, insulin resistance, and hyperinsulinemia. - specific reasons for the development of lipodystrophy are unclear

question

buffalo hump

answer

the accumulation of fatty tissue at the base of the neck

question

lipomas

answer

benign tumors composed of fatty tissue

question

weight loss and wasting

answer

- Even with effective treatment of HIV infection, weight loss and wasting are ongoing problems for many HIV-infected patients. - wasting has been linked with accelerated disease progression, reduced strength, and fatigue. - In the later stages of AIDS, the wasting is severe and increases the risk of death. - high kcalorie, high protein diet

question

HIV associated wasting

answer

is diagnosed in patients who unintentionally lose 5% of body weight within 3 months, 7.5% within 6 months, or 10% within 12 months.

question

wasting associated with HIV infection has many causes

answer

anorexia and inadequate food intake, altered metabolism, malabsorption, chronic diarrhea, and diet-drug interactions.

question

Inadequate food intake

answer

is a key factor in the development of wasting

question

factors that result in poor food intake

answer

emotional distress, pain, and fatigue oral infections respiratory disorders cancer medications

question

emotional distress, pain, and fatigue

answer

the physical and social problems that accompany chronic illness may cause fear, anxiety, and depression, which contribute to anorexia. Pain and fatigue, which may be associated with some disease complications, can cause anorexia and difficulty with eating.

question

oral infections

answer

oral infections associated with HIV infection can cause discomfort and interfere with food consumption common infections: - candidiasis: a fungal infection on the mucous membranes of the oral cavity and elsewhere - herpes simplex virus: a common virus that can cause blisterlike lesions on the lips and in the mouth

question

respiratory disorders

answer

Respiratory infections, including pneumonia and tuberculosis, are common in people with HIV infection. Symptoms may include chest pain, shortness of breath, and cough, which interfere with eating and contribute to anorexia

question

cancer

answer

cancer leads to anorexia for numerous reasons Kaposi's sarcoma: a common cancer in HIV-infected persons that is characterized by lesions in the skin, lungs, and GI tract

question

medications

answer

medications given to treat HIV infection, other infections, and cancer often cause anorexia, nausea and vomiting, altered taste sensation, food aversions, and diarrhea

question

GI tract complications

answer

- complications of HIV infection involving the GI tract may result from opportunistic infections, medications, or the HIV infection itself - infections may develop in the esophagus, stomach, and intestines. - medications that treat viral, parasitic, and fungal infections in the GI tract can contribute to bacterial overgrowth - many patients develop nausea, vomiting, and diarrhea from the medications used to suppress HIV - as a result of these multiple problems, HIV-infected patients using standard treatments face an extremely high risk of malnutrition due to the combination of GI discomfort, bacterial overgrowth, malabsorption, and nutrient losses from vomiting, steatorrhea, and diarrhea

question

Patients in the advanced stages of HIV infection

answer

often develop pathological changes in the small intestine referred to as AIDS enteropathy

question

AIDS enteropathy

answer

condition is characterized by villus atrophy and blunting, intestinal cell losses, and inflammation - result is a substantial reduction in the intestinal absorptive area, causing malabsorption, diarrhea, and weight loss

question

neurological complications

answer

- may be a consequence of HIV infection, immune suppression (causing cancers and infections that target brain tissue), or the medications used to treat HIV infection - clinical features include mild to severe dementia, muscle weakness and gait disturbances, and pain, numbness, and tingling in the legs and feet - neurological impairments are usually more pronounced in the advanced stages of AIDS

question

other complications of HIV

answer

- patients with HIV infection can develop anemia due to nutrient malabsorption, blood loss, disturbed bone marrow function, medication side effects, or the chronic illness itself - HIV infection may also lead to skin disorders (rashes, infections, and cancers), eye disorders (retinal infection or detachment), kidney diseases (nephrotic syndrome or chronic kidney disease), and coronary heart disease

question

treatments for HIV infection

answer

- treatments can help to slow its progression, reduce complications, and alleviate pain - standard drug treatment for suppressing HIV infection is a combination of at least three antiretroviral drugs

question

antiretroviral drugs

answer

- side effects include skin rashes, headache, anemia, tingling and numbness, hepatitis, pancreatitis, and kidney stones - antiretroviral therapy has improved the life span and quality of life for many patients, the drug regimens are difficult to adhere to and cause complications that require continual management

question

In addition to antiretroviral drugs, adjunct drug therapies may be necessary to prevent or treat infections, treat HIV-associated cancers, or manage other complications that arise over the course of illness.

answer

Medications are often prescribed to treat vomiting, anorexia, diarrhea, pain, blood lipid abnormalities, or glucose intolerance

question

control of anorexia and wasting

answer

anabolic hormones, appetite stimulants, and regular physical activity have been successful in reversing unintentional weight loss and increasing muscle mass in HIV-infected patients

question

Testosterone and human growth hormone

answer

have demonstrated positive effects on muscle tissue, especially in combination with resistance training

question

excercise

answer

A regular program of resistance exercise improves muscle mass and strength and corrects some of the metabolic abnormalities (altered blood lipids and insulin resistance) that are common in HIV-infected patients

question

medications megestrol acetate and dronabinol

answer

are sometimes prescribed to stimulate appetite and improve weight gain, although much of the weight increase is attributable to a gain of fat rather than lean tissue

question

control of lipodystrophy

answer

- Treatment strategies for lipodystrophy are under investigation - both aerobic activity and resistance training may help to reduce abdominal fat, although some patients opt for cosmetic surgery - patients may be given alternative antiretroviral drugs to alleviate symptoms - medications may be prescribed to treat abnormal blood lipid levels and insulin resistance

question

alternative therapies

answer

- Like cancer patients, people with HIV infection and AIDS are frequently tempted to try unconventional methods of treatment - although many alternative therapies are harmless, some may have side effects that worsen complications or interfere with treatment - monitoring patients' use of dietary supplements is essential to reduce the likelihood of adverse effects or diet drug interactions.

question

herbal preparations that contain St. John's wort, echinacea, or garlic

answer

may reduce the effectiveness of some antiretroviral drugs

question

Zinc megadoses

answer

may increase the progression of HIV infection

question

nutrition therapy for HIV infection

answer

- HIV-infected individuals must learn how to maintain body weight and muscle mass, prevent malnutrition, and cope with nutrition-related side effects of medications

question

nutrition assessment and counseling

answer

should begin soon after a patient is diagnosed with HIV infection - initial assessment should include an evaluation of body weight and body composition - follow-up measurements may indicate the need to adjust dietary recommendations and drug therapies

question

since the development of successful drug therapies for HIV infection

answer

obesity and overweight have become more prevalent than wasting among HIV-infected individuals in the United States

question

excessive body weight

answer

can increase risks for cardiovascular disease and diabetes, moderate weight loss is recommended for patients with HIV infection who are overweight or obese

question

daily energy needs

answer

may range from 30 to 40 kcalories per kilogram body weight, and protein requirements may be as high as 1.2 to 2.0 grams per kilogram body weight per day

question

individuals who are using antiretroviral drugs

answer

- frequently develop insulin resistance and elevated triglyceride and LDL cholesterol levels - treating these problems often requires both medications and dietary adjustment

question

metabolic complications

answer

- patients should be advised to achieve or maintain a desirable weight, replace saturated fats with monounsaturated and polyunsaturated fats, increase fiber intake, and limit intakes of trans-fatty acids, cholesterol, added sugars, and alcohol - regular physical activity can improve both insulin resistance and blood lipid levels - if problems persist, alternative antiretroviral medications may be prescribed in an attempt to improve the metabolic abnormalities

question

vitamin and mineral needs of people with HIV infection

answer

- highly variable, and little information is available concerning specific needs - because nutrient deficiencies are likely to result from reduced food intake, malabsorption, diet-drug interactions, and nutrient losses, multivitamin-mineral supplements are usually recommended - patients should be cautioned to maintain intakes that are close to DRI recommendations, however, due to the risk of adverse interactions between excessive amounts of certain nutrients and antiretroviral drugs

question

symptom management

answer

- discomfort associated with antiretroviral therapy, opportunistic GI infections, and symptoms of malabsorption can make food consumption difficult, and problems such as vomiting and diarrhea contribute to fluid and electrolyte losses

question

cryptosporidiosis

answer

a foodborne illness caused by the parasite Cryptosporidium parvum

question

food safety

answer

- the depressed immunity of people with HIV infections places them at extremely high risk of developing foodborne infections - health practitioners should caution patients about their high susceptibility to foodborne illness and provide detailed instructions about the safe handling and preparation of foods; for some individuals, a low- microbial diet may be suggested

question

water

answer

- can also be a source of foodborne illness and is a common cause of cryptosporidiosis in HIV-infected individuals - in places where water quality is questionable, patients should consult their local health departments to determine whether the tap water is safe to drink - if not, or to take additional safety measures, water used for drinking and making ice cubes should be boiled for one minute

question

enteral and parenteral nutrition support

answer

- in later stages of illness, people with HIV infections may be unable to consume enough food and may need aggressive nutrition support

question

tube feedings

answer

are preferred whenever the GI tract is functional; they can be provided at night to supplement oral diets consumed during the day

question

parenteral nutrition

answer

reserved for patients who are unable to tolerate enteral nutrition, such as those with GI obstructions that prevent food intake

question

individuals with severe malabsorption

answer

orally administered hydrolyzed formulas containing medium-chain triglycerides may be as effective as parenteral nutrition for reversing weight loss and wasting

question

for either type of nutrition support

answer

careful measures are necessary to avoid bacterial contamination of nutrient formulas and feeding equipment

Ch 23- Nutrition, Cancer, and HIV infection – Flashcards

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