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Position of the American Dietetic Association: Nutrition Intervention and Human Immunodeficiency Virus Infection

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Abstract

It is the position of the American Dietetic Association that efforts to optimize nutritional status through individualized medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential to the total system of health care available to people with human immunodeficiency virus (HIV) infection throughout the continuum of care. Broad-based efforts to improve health care access and treatment have stabilized HIV prevalence levels in many parts of the world and led to longer survival for people living with HIV infection. Confounding clinical and social issues, such as medication interactions, comorbidities, wasting, lipodystrophy, food insecurity, aging, and other related conditions further complicate disease management. With greater understanding of the mechanisms of HIV disease and its impact on body function, development of new treatments, and wider ranges of populations affected, the management of chronic HIV infection continues to become more complex and demanding. Achievement of food and nutrition security and management of nutrition-related complications of HIV infection remain significant challenges for clients with HIV infection and health care professionals. Registered dietitians and dietetic technicians, registered, should integrate their efforts into the overall health care strategies to optimize their clinical and social influence for people living with HIV infection.

Section snippets

Position Statement

It is the position of the American Dietetic Association that efforts to optimize nutritional status through individualized medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential to the total system of health care available to people with human immunodeficiency virus infection throughout the continuum of care.

Human immunodeficiency virus (HIV) infection is part of social, political, and economic struggles worldwide. These issues present

Food and Nutrition Insecurity

In addition to HIV disease and its complications, many clients face economic insecurity, social isolation and stigmatization, incarceration or institutionalization, substance use, and additional comorbidities. As a result, many people with HIV and AIDS face hunger and multiple barriers to food and nutrition security. “Food availability and good nutrition are thus essential for keeping people living with HIV healthy for longer” and able to resist opportunistic infections such as tuberculosis,

Assessment

Nutrition plays an essential role in supporting the health and quality of life of people living with HIV. The negative effects of malnutrition are often preventable and are usually not easily reversed. Nutrition-related alterations can occur early in HIV infection; thus, nutrition intervention should begin soon after diagnosis. This part of the Nutrition Care Process includes assessment and diagnosis features. A complete assessment includes collecting timely and appropriate data, analyzing and

Interventions

Reducing or eliminating malnutrition has the potential to significantly slow progression of disease, decrease its severity, and improve longevity (74, 76, 80). Individualized care that integrates medical and social services and is delivered by health care professionals with HIV-related experience, training, and expertise is necessary for optimal success (81, 82). This part of the Nutrition Care Process includes planning nutrition interventions, implementing nutrition interventions, and

Reimbursement for Nutrition-Related Services

Reimbursement for health care, including MNT and supplements, is important for the access and integration of nutrition care and should be a part of efforts to improve access to care in the United States. Several sources of payment may be available, depending on insurance coverage, enrollment in state and federal support programs, and other resources. In some cases, AIDS Drug Assistance Programs and Medicaid programs may provide for medically necessary nutrient supplementation. In 2006, the Ryan

Professional Resources

Because the research in HIV infection and related disease is constantly changing, RDs and DTRs and other care providers should keep updated on the evidence, guidelines, and experiences. Figure 2 contains information on selected resources for nutrition-related information for the care and treatment of people living with HIV.

Roles and Responsibilities of RDs and DTRs

RDs and DTRs can be instrumental in ensuring that diet and nutritional status are optimized in clients with HIV infection. The roles and responsibilities of RDs and DTRs include:

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    educating clients and their caregivers on the role of nutrition and diet in both restoration and maintenance of health;

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    initial and periodic assessment of client nutritional status and challenges to maintenance and restoration of nutritional status to develop and update nutrition-related strategies with clients and

Conclusions

It is clear that the influence of disease on nutritional status can affect the overall health and longevity of people living with HIV infection; however, the influence of nutrition interventions on HIV disease is limited. There is some research that supports the positive role of nutrition intervention in the improvement of health for children and adults with HIV (74, 76, 80, 144). More research is needed to understand the influence of nutrition on health, disease, and survival in HIV infection.

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