HIV :: Role of Nutrition in Health Care for People with HIV/AIDS
The American Dietetic Association commends Congress for passing a three-year reauthorization of the Ryan White CARE Act, the largest federal program specifically for people with HIV and AIDS, with new attention to the unique dietary needs of patients.
ADA has strongly supported the Ryan White CARE legislation and has worked to include the expansion of nutrition services provided by registered dietitians, positively affecting the nutritional health of millions of people.
?The importance of nutrition and especially medical nutrition therapy to the treatment and management of HIV disease cannot be overstated. MNT has become a critical element of disease management for persons living with HIV/AIDS,? said registered dietitian and ADA president Judith A. Gilbride.
?This was a priority issue for us,? Gilbride said, ?where the evidence was compelling that nutrition care and services, as well as MNT, would save lives.?
The bill, which has been sent to President Bush for his signature, specifies that medical nutrition therapy will be a core medical service. Seventy-five percent of all program funding is directed to go to core medical services for HIV/AIDS patients. ADA urges President Bush to sign this crucial legislation without delay, to improve quality of life and possibly reduce mortality for people living with HIV.
ADA submitted evidence to Congress showing that modern management of HIV requires substantial expertise in dealing with nutrition issues and that patient access to this expertise has been limited because MNT was not previously specified in RWCA.
Since nearly the beginning of the HIV/AIDS epidemic, the relationship between nutrition and survival has been clear. The patient?s nutritional status is strongly predictive of survival during the course of HIV infection. Achieving optimal nutritional status enhances the quality of life of people living with HIV and decreases the risk of opportunistic infections, which frequently cause or significantly contribute to death.
MNT has become a critical element of disease management for persons living with HIV/AIDS. While active HIV disease alone creates nutritional complications, the lifelong pharmacotherapy presents additional unique challenges to the patient. The antiretroviral and other medications introduce adverse interactions with food, metabolic changes including elevated levels of blood glucose and lipids and debilitating gastrointestinal side effects including diarrhea and loss of appetite.
The medications can also lead to a redistribution of body fat from the face and limbs to the back and the belly, creating further challenges to patients adhering to their drug regimens and the need for optimal nutrition to attain and maintain muscle mass and optimal body weight. MNT, along with exercise, helps patients fight this condition, called lipodystrophy.
Pregnancy in HIV-infected women is not uncommon; and nutrition intervention becomes even more critical because of additional needs for nutrients and energy to support normal fetal growth. Access to MNT is particularly critical for pregnant women and plays a role in the delivery of a healthy baby.
A registered dietitian working with HIV/AIDS patients provides care and counseling to optimize patient nutrition status and immunity and works with the patient develop a culturally appropriate diet to ensure against nutrient deficiencies. The goals of MNT also include attaining and maintaining optimal body composition and weight; and, most importantly, maximizing the effectiveness of and adherence to antiretroviral drug therapies through eating strategies tailored to each patient?s living situation and preferences.
As MNT helps improve the effectiveness and tolerance of medications, it also helps patients adhere to medication regimens by managing adverse drug reactions like nausea, diarrhea, fatigue and changes in appetite. Metabolic and morphological abnormalities ? such as cachexia (physical wasting with loss of body weight and muscle mass) ? occur in HIV/AIDS patients and are associated with increased morbidity and mortality. Symptoms of adverse drug reactions ? such as hypertension, high blood cholesterol and triglyceride levels and insulin resistance ? also can be managed in part by MNT.
MNT has been shown to be effective in treating diabetes and pre-diabetes, kidney disease, dyslipidemia, hypertension and other chronic heart and circulatory diseases, cancer care, osteoporosis, chronic obstructive pulmonary disease, severe burns and physical trauma. Over the past five years, Medicare has covered MNT provided by RDs for diabetes and kidney disease. Federal legislation is pending to expand Medicare MNT coverage.
?Among the many options for improving Americans? health and in managing disease, nutrition therapies are among the most cost effective,? Gilbride said. ?ADA is active on a range of policies to help Americans choose diets to keep them healthy longer, and to inform and educate the public about nutrition?s role in disease prevention and management. ADA wants all people to have access to MNT in the care and treatment of specific conditions and diseases.?
With approximately 65,000 members, the American Dietetic Association is the nation?s largest organization of food and nutrition professionals. ADA serves the public by promoting optimal nutrition, health and well-being.