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Symptomatic stage
Management of Nutritional Effects
HIV-related opportunistic infections
Traditional healers and medicine
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HIV/AIDS and malnutrition are interrelated. In fact,
in Africa AIDS was initially known as 'slim disease' because of the
wasting syndrome typically experienced by people with the disease.
Research suggests that malnutrition increases the risk of
progression of HIV infection, and it may also increase the risk of
HIV transmission from mother to baby. In turn, HIV infection makes
malnutrition worse through its attacks on the immune system and its
impact on nutrient intake, absorption and the body's use of food.
Malnutrition associated with HIV infection has serious and direct
implications for the quality of life of people with HIV/AIDS. Weight
loss is often the event that begins a vicious circle of increased
fatigue and decreased physical activity, including the inability to
prepare and consume food and reduced work productivity.
In people with symptomatic HIV disease there are
likely to be several overlapping processes taking place:
This may be due to painful sores in the mouth.
Fatigue, depression, changes in mental state and other psychological
factors may also play a role by affecting a person's appetite and
interest in food. Economic factors also affect food availability and
the nutritional quality of food. Side effects from medications can
also result in lower dietary intakes that can cause weight loss
associated with HIV/AIDS.
Malabsorption accompanies the frequent bouts of
diarrhoea that affect people with HIV as a result of various
infections. It is also believed that HIV infection itself may cause
nutrient malabsorption.
HIV infection results in increased energy and
protein need as well as inefficient use and loss of nutrients.
Changes in metabolism occur during HIV infection from severe
reductions in food intake as well as from the immune system's
response to the infection.
When food is restricted, the body responds by
altering insulin and glucagon production, which regulate the flow of
sugar and other nutrients in the intestine, blood, liver and other
body tissues. Over time, the body uses up its carbohydrate stores
from muscle and liver tissue and it begins to break down body
protein to produce glucose. This process causes protein loss and
muscle wasting.
Management of weight loss in HIV/AIDS is complicated
by the fact that these three mechanisms are not mutually exclusive.
Weight loss and wasting in people with AIDS may be the result of all
three processes.
For the first two causes of weight loss and wasting,
malnutrition can be reduced by treating the immediate sources of the
problem (e.g. oral thrush, mouth sores, other infections) and
providing foods that are soft and well tolerated by the infected
person. People with diarrhoea should take plenty of fluids or use
oral rehydration solutions to avoid dehydration and replace the lost
fluids in the body. Also, if possible people with symptomatic HIV
should try to eat as frequently as possible, even if the amounts of
food are very small each time.
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People with advanced HIV infection are vulnerable to
infections or malignancies that are called 'opportunistic
infections' (OIs) because they take advantage of the opportunity
offered by a weakened immune system.
Providing prevention and treatment of OIs and
HIV-associated diseases can:
• Reduce the suffering of people living with
HIV/AIDS and improve their quality of life and the quality of life
for their families.
• Allow people with HIV/AIDS to continue as
contributing members of their families and communities for as long
as possible.
• Prevent the further spread of TB and other
transmittable opportunistic infections.
A partial list of the world's most common
opportunistic diseases and infections includes:
• Bacterial diseases such as tuberculosis (TB),
Mycobacterium avium complex disease (MAC), bacterial pneumonia and
septicaemia ('blood poisoning').
• Protozoal diseases such as pneumocystis carinii
pneumonia (PCP), toxoplasmosis, microsporidiosis, cryptosporidiosis,
isopsoriasis and leishmaniasis
• Fungal diseases such as candidiasis,
cryptococcosis (cryptococcal meningitis (CRM)) and penicilliosis
• Viral diseases such as those caused by
cytomegalovirus (CMV), herpes simplex and herpes zoster virus
• HIV-associated malignancies such as Kaposi
sarcoma, lymphoma and squamous cell carcinoma
Find out more about the prevention, treatment and
care of HIV related OIs in resource poor countries.
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Traditional treatments for HIV/AIDS can be
attractive as they are accessible, culturally appropriate and
acceptable and may be affordable in resource poor countries.
Traditional medicine differs greatly from region to region and is
often very specific to a location. People with HIV/AIDS often become
frustrated with management of their disease and many are willing to
try anything in the hope of staying healthy for longer.
There is little evidence that such therapies are
safe or effective in treating HIV infection. Whilst some of the
traditional treatments maybe helpful, others may do more harm than
good. Traditional medicine should not replace more proven modern
treatments if they are available. However, in the absence of such
treatments, traditional medicine can be a feasible option if it
relieves pain and makes the patient feel better.
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