Nutrition & HIV Program

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Nutrition & HIV Program

    HIV Nutrition & Food

    Selected Guides and Resources

    ―Now more than ever, the management of HIV disease necessitates substantial expertise in nutrition. Ideally, all PLWH/A should have access to the services of a registered dietitian with expertise in HIV/AIDS who can provide nutrition assessments, counseling, and education and help determine whether the client has adequate access to food.‖

    Nutrition and HIV/AIDS. HRSA CARE Action August 2004: or or 888-ask-hrsa.

    ―It is the position of the American Dietetic Association and Dietitians of Canada that efforts to optimize nutritional status, including medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential components of the total health care available to people with human immunodeficiency virus (HIV) infection throughout the continuum of care.‖

    Position of the American Dietetic Association and Dietitians of Canada: Nutrition intervention in the care

    of persons with human immunodeficiency virus. J Am Diet Assoc. 2004;104:1425-1441 (Expires 2009)

    ―Patients should be entered into a continuum of medical care and services including…nutritional services with the availability of professional referral and consultation.‖

    Guidelines for use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents

    www.aidsinfo.nih/gov/contentfiles/adultandadolescentsGL032320040003.pdf (3/23/2004)


? HIV Medical Nutrition Therapy and Related Guides ? Selected HIV Nutrition Articles

    ? ADA Evidence Analysis Library & HIV Nutrition ? HIV Nutrition Professionals

    ? Nutrition Fact Sheets in English & Spanish ? Nutrition Care Process, Model, & Standardized Terms

    ? HIV Medical & Nutrition-Related Information ? Associations & Organizations

    ? Weight, Anthropometry, Equations, Definitions, Flow ? Medicare MNT CPT and G Codes and Definitions

    Sheet, ? Recommended MNT Performance Measurements

    ? Dietary Guidelines, Food Composition & Diet Analysis ?Action Plan for Implementing MNT in HIV Medical

    ? Food Security Programs and Resources Clinic

    ? Los Angeles County Food, Nutrition, & HIV Resources ?HIV Nutrition Screening Tools

    ? International HIV Nutrition

    HIV Medical Nutrition Therapy and Related Guides

    Position of the American Dietetic Association and Dietitians of Canada: Nutrition intervention in the care of persons with human immunodeficiency virus

     J Am Diet Assoc. 2004;104:1425-1441 (Expires 2009)

Los Angeles County Commission on HIV Standards of Care

     Medical Nutrition Therapy Standards of Care, September 2005

     Includes: Nutrition Screen & Referral Criteria for Adults (18+ Years) with HIV/AIDS (ADA MNT Evidence-

    Based Guides for Practice, March 2005)

     Medical Outpatient Standards of Care, January 2006

    HIV Nutrition Selected Guides & Resources, updated August 2008, page 1 of 43 Marcy Fenton MS RD Office of AIDS Programs and Policy, Los Angeles County Department of Public Health

A Practical Guide to Nutrition for People Living with HIV

    Diana Johansen, BSc, RD Canadian AIDS Treatment Information Exchange (CATIE) 2007 in English and French

Health Care and HIV: Nutritional Guide for Providers and Clients

    Health Resources and Services Administration, HIV/AIDS Bureau. An extensive nutrition manual in English and Spanish, it includes practical handouts, tools and algorithms, and HIV/AIDS Medical Nutrition Therapy Protocols for Adults and for Children from Medical Nutrition Therapy Across the Continuum of Care (ADA, 1998). Found

    at AIDS Education and Training Center: (new

    web address)

Health Maintenance and Disease Prevention Nutrition

    AIDS Education Training Center: Section 2 in Clinical Manual for Management of the HIV-Infected Adult, 2005


The HIV Medicine Self-Directed Study Guide, 2003 Edition, Volume 1

    Objective II.69, 16-3 to 16-5, American Academy of HIV Medicine (AAHIVM)

    1. Medical nutrition therapy includes nutrition assessment, counseling, and therapy interventions provided by

    registered dietitians and is increasingly regarded as important for HIV+ persons. 2. The physician‘s written referral to the dietitian should include basic patient profile information, current

    symptoms, and the order for MNT, with signature and contact information for the treating physician.

Medical Nutrition Therapy in Human Immunodeficiency Virus (HIV) Infection thFenton M and Silverman E. in Krause’s Food, Nutrition, and Diet Therapy, 12 Edition, edited by L. K. Mahan

    and S. Escott-Stump, Elsevier/Saunders, 2008.

HIV/AIDS Medical Nutrition Therapy Protocols, Adults

    HIV/AIDS Medical Nutrition Therapy Protocols, Pediatric ndFrom Medical Nutrition Therapy Across the Continuum of Care, 2 Edition (ADA, 1998), found online in Health

    Care and HIV: Nutritional Guide for Providers and Clients at


     ndMedical Nutrition Therapy Across the Continuum of Care, 2 Edition (ADA, 1998)

    ; The disease-specific protocols included in the Medical Nutrition Therapy Across the Continuum of Care are

    in the process of being revised using ADA's evidence analysis process. Until the new evidence-based

    practice guidelines/MNT protocols are completed, practitioners can use the disease-specific protocols in

    Medical Nutrition Therapy Across the Continuum of Care.

    1. Cancer (medical) 9. HIV/AIDS, pediatric

    2. Cancer (radiation oncology) 10. Hyperlipidemia

    3. Chronic obstructive pulmonary disease 11. Hypertension

    4. Cystic Fibrosis 12. Irritable Bowel Syndrome

    5. Diabetes Mellitus, type 1 13. Pneumonia

    6. Diabetes Mellitus, type 2 14. Pre-end-stage Renal Disease

    7. Diabetes Mellitus, type 3 15. Prenatal, high-risk

    8. HIV/AIDS, adult

    ; The CD-ROM Nutrition Practice Guidelines have replaced the protocols for the following diseases in the

    Medical Nutrition Therapy Across the Continuum of Care publication: Type 1 and Type 2 Diabetes

    Mellitus; Nutrition Practice Guidelines for Gestational Diabetes Mellitus; Hyperlipidemia Medical Nutrition

    Therapy Protocol; and Chronic Kidney Disease (non-dialysis) Medical Nutrition Therapy Protocol

Integrating Nutrition into Medical Management of HIV

    Clinical Infections Diseases April 2003, Volume 36 Supplement 2, edited by Celia Hayes MPH RD


    ; Introduction: Integrating Nutrition Therapy into Medical Management of Human Immunodeficiency Virus

    Author: John G. Bartlett

    HIV Nutrition Selected Guides & Resources, updated August 2008, page 2 of 43 Marcy Fenton MS RD Office of AIDS Programs and Policy, Los Angeles County Department of Public Health

; General Nutrition Management in Patients Infected with Human Immunodeficiency Virus

    Authors: Judith Nerad; Mary Romeyn; Ellyn Silverman; Jackie Allen-Reid; Doug Dieterich; Jill Merchant;

    Veronique Pelletier; Donna Tinnerello and Marcy Fenton

    ; Assessment of Nutritional Status, Body Composition, and Human Immunodeficiency Virus-Associated

    Morphologic Changes

    Authors: Tamsin Knox; Melissa Zafonte-Sanders; Cade Fields-Gardner; Karol Moen; Diana Johansen and

    Nicholas Paton

    ; Weight Loss and Wasting in Patients Infected with Human Immunodeficiency Virus

    Authors: Steven Grinspoon and Kathleen Mulligan

    ; Lipid Abnormalities

    Authors: Michael Dube and Marcy Fenton

    ; Body Habitus Changes Related to Lipodystrophy

    Author: Fred Sattler

    ; Insulin and Carbohydrate Dysregulation

    Author: Marie C. Gelato

    ; Lactic Acidemia in Infection with Human Immunodeficiency Virus

    Author: Andrew Carr

    ; Emerging Bone Problems in Patients Infected with Human Immunodeficiency Virus

    Authors: Kristin Mondy and Pablo Tebas

    ; Food and Water Safety for Persons Infected with Human Immunodeficiency Virus

    Authors: Celia Hayes; Elisa Elliot; Edwin Krales and Goulda Downer

Nutrition and HIV/AIDS

    HRSA CARE Action August 2004: or or 888-ask-


Nutrition in Clinical Practice

    August 2004 issue of Nutrition in Clinical Practice is devoted to HIV nutrition. Nutrition in Clinical Practice Volume 19 Number 4, August 2004.

    Nutrition Guidelines for Agencies Providing Food to People Living with HIV Disease Parenteau J, Edelman D, Gylnn K, and House A. Association of Nutrition Services Agencies, 2002

Nutrition and Hydration

    Chapter 24 in A Clinical Guide on Supportive and Palliative Care for People with HIV/AIDS 1-888-ASK-HRSA (1-888-275-4772) or PDF online

Tufts Nutrition & HIV

    Includes: nutrition fact sheets and diet information, research reports and links

Nutrition and Exercise HIV/AIDS Information

Nutrient requirements for people living with HIV/AIDS

    World Health Organization, 2003:

    ADA Evidence Analysis Library? & HIV Nutrition

ADA Evidence Analysis Library?

    American Dietetic Association:

    Content is available free to ADA members. A growing synthesis of research, site includes nutrition-related diseases & conditions, nutrition care process, foods, and nutrients, evidence-based nutrition practice guidelines, research article analysis, toolkits, as well as tutorials (, and more.

Diseases and conditions in ADA Evidence Analysis Library?:

     Adult weight management Chronic obstructive pulmonary HIV/AIDS

    disease Nutrition in athletic Hydration

    performance Critical illness Diabetes 1 & 2 Hypertension

     Nutrition care in bariatric Disorders of lipid metabolism Oncology

    surgery Gestational diabetes Pediatric weight management

     Breastfeeding Gluten intolerance / celiac disease Spinal cord injury

     Chronic overweight Heart failure Unintended weight loss

     Chronic kidney disease (CKD)

Nutrients in ADA Evidence Analysis Library?:

     Macronutrients Micronutrients Coenzyme Q10 & Compounds

     Fiber Amino acids

Foods in ADA Evidence Analysis Library?:

     Aspartame Nuts Meat and Beans

     Non-nutritive sweetener Grains Oils

     Vegetarian Nutrition Vegetables Discretionary Calories

     Physical activity Fruits Sugars and sweets

     Fish Dairy

Resources in ADA Evidence Analysis Library?:

     Energy Expenditure: Measurement vs. Estimation

    HIV Nutrition Evidence Analysis Questions, Evidence Conclusion Statements, & Grades Work on analyzing the evidence in HIV nutrition has begun with those completed questions and their

    conclusion statements listed below. For more information see:

    Grades: Overall strength of the available supporting evidence:

    Grade I - good; Grade II - fair; Grade III - limited; Grade IV - expert opinion; Grade V: not assignable

What is the evidence to support Medical Nutrition Therapy for people with HIV infection?

    Seven studies were evaluated regarding Medical Nutrition Therapy (MNT) and/or nutrition counseling in

    people with HIV infection. One study completed prior to highly active antiretroviral therapy stressed that

    early intervention may prevent progressive weight loss. Four studies regarding MNT report improved

    outcomes related to cardiovascular risk indices, caloric intake, and/or symptoms, with or without oral

    nutritional supplementation, especially with increased frequency of visits. Two studies regarding

    nutritional counseling (non-MNT) also report improved outcomes related to weight gain, CD4 count and/or

    quality of life.

    Grade I

     What is the evidence to support education on foodborne illness for people with HIV infection and their


    Six studies were evaluated regarding education on foodborne illness in people with HIV infection. One

    narrative review concluded that people with HIV infection are more susceptible to foodborne illness. Two

    studies reported confusion and lack of knowledge regarding food safety. Two studies evaluating home-

    delivered meals programs for people with HIV infection report strong adherence to food safety guidelines

    in the preparation and delivery of meals. One study evaluating a program which included a component of

    foodborne illness education demonstrated a decrease in the number of symptoms and eating difficulties in

    people with HIV infection.

    Grade I

What are the caloric needs of people with HIV infection?

    Twenty-four studies were evaluated regarding caloric needs in people with HIV infection. Eight out of nine

    studies report increased resting energy expenditure in people with HIV infection, compared to healthy

    controls. However, total energy expenditure may be similar to that of control subjects. Energy balance

    deficits result in growth failure in children with HIV infection. Factors related to energy balance in people

    with HIV infection include malabsorption, oral symptoms and trouble swallowing, effects of medications,

    inflammation, viral load, body fat redistribution and lipodystrophy. Further research is needed regarding

    caloric requirements in people with HIV infection.

    Grade II

What is the evidence to support a particular dietary intake of protein for people with HIV infection?

    While diets that are higher in protein appear to be beneficial, protein requirements, protein turnover and

    the effects of increasing protein intake were not addressed in these studies. Further research regarding

    the dietary intake of protein in people with HIV infection is warranted.

    Grade III

What is the evidence to support the consumption of specific fatty acids for people with HIV infection?

    Limited evidence supports the consumption of specific fatty acids to improve various outcomes. Further

    research regarding the consumption of fatty acids in people with HIV infection is warranted.

    Grade III

What is the evidence to support a particular dietary intake of carbohydrate for people with HIV infection?

    Limited evidence supports a relationship between fiber or glycemic index with fat deposition. Further

    research regarding the dietary intake of carbohydrate in people with HIV infection is warranted.

    Grade III

For additional information from the ADA Evidence Analysis Library regarding:



     Evidence Analysis Manual:


     ADA Evidence Library:

    Nutrition Fact Sheets in English and Spanish

AIDS Project Los Angeles

    APLA Nutrition Education Fact Sheets in English and Spanish languages, resources and links, etc.: Go to, click Programs & Services and then click Nutrition Education, or go directly:

     HIV Nutrition Education:

     Nutrición Hojas informativas:

    APLA Nutrition Fact Sheets

     Anemia Fat Oral Health

     Anthropometric Procedures Fatigue Protein

     Basics Food and Water Safety Seasonal Produce

     Be Prepared When Disaster Heartburn Side Effects

    Strikes Hepatitis C and Diet Summer Picnic Safety Tips

     BIA Glossary HIV Medical Nutrition Thermometer Tips

APLA Nutrition Fact Sheets

    Therapy Bone Health Lowering Cholesterol and

     How to Find a Registered Triglycerides Carbohydrates

    Dietitian Water Diarrhea

     Lactose Intolerance What Food and How Much Eat and Travel Safely

     Let‘s Talk Turkey Eating on a Budget


Association of Nutrition Services Agencies

    Nutrition Guidelines;, (Resources ANSA Publications Nutrition Fact Sheets

    ANSA Nutrition Fact Sheets

     Introduction Constipation 10 Tips for good Nutrition

    on a Fixed Budget Protein Content of Foods Lactose intolerance

     Oral Candidiasis (Thrush) General Nutrition GERD

    Requirements Proper Brushing and Lab Tests

    Flossing Carbohydrates Food/Medication Chart

     Going to the Dentist The Importance of Fiber Food Safety for Persons

     Managing Cholesterol and Taste Changes Living with HIV/AIDS

    Triglycerides (Blood Lipids) Eating Problems & Poor Water Safety

     Diabetes, Pre-Diabetes & Appetite Nutrition Therapy for High

    Insulin Resistance Self- Early Fullness Blood Pressure

    Management Difficulty Chewing or Restricted Sodium Meal Plan

     Gain and Loss of Fat Swallowing Vegetarian Diets

     Bone Health Diarrhea Supplements and

     Anorexia and Wasting Nausea Complementary Therapies


Cuidado de la Salud y el VIH: Guía Nutricional Para Profesionales de la Salud y Pacientes

    Spanish language version of Health Care and HIV: Nutritional Guide for Providers and Clients, Health

    Resources and Services Administration, HIV/AIDS Bureau; extensive manual in English and Spanish at AIDS

    Education and Training Center

Nutricion, materiales disponibles

    University of Utah Health Sciences Center


Nutrición y salud

    Produced in Mexico, appears comprehensive:

The American Academy of Family Physicians

    Nutrition related topics with the link to a Spanish language translation available from the particular issue

    written in English:

Extensión en Español

    A catalogue of materials produced by an organization of Extension professionals from the Cooperative

    Extension system

American Sign Language: Food Safety Videos

    SignFSIS video-casts in American Sign Language featuring text-captioning are designed to inform deaf and hard-

    of-hearing consumers about foodborne illness and raise the level of awareness of the dangers associated with

    improper handling and undercooking of food

     HIV Medical- & Nutrition-Related Information

AIDS/HIV General Resources

    United States Department of Agriculture Food and Nutrition Information Center (USDA/FNIC)


    Up-to-date HIV/AIDS treatment guidelines, information on drugs, clinical trials, and vaccine development, and other resources, such as a glossary of important terms, helpful fact sheets and links.

AIDS Living with AIDS

    Information and links to more resources about HIV disease, drugs and treatment, nutrition, clinical trials, complementary care and resources, also in Spanish. MedlinePlus is a service of the National Library of Medicine, part of the National Institutes of Health.

American Heart Association

    Includes new dietary recommendations, 2006 Diet and Lifestyle Recommendations, healthy lifestyle, exercise, food shopping, recipes,

    diets, tools for tracking lab results, diet and exercise and measuring risk. See

CDC HIV/STD/TB Prevention News Update

    The CDC National Center for HIV, STD and TB Prevention provides synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis each weekday and many other pertinent resources; conferences, links, etc:


    National Cholesterol Education Program, includes program history

    and description, Health Related Information for clients, the general public and health professionals, Clinical Practice Guidelines for Cholesterol Management in Adults (ATP III), a risk assessment tool:, and other information.

Cryptosporidium Prevention

    CDC Division of Parasitic Diseases: Fact sheets regarding Compromised Persons for the public & health care & public health professionals. Includes extensive safe water recommendations (last reviewed: 4/2008)

Dyslipidemia & HIV

    Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIVMA of IDSA and the ACTG. Dubé et al CID 2003:37;613-27

Food and Drug Administration

    HIV/AIDS: therapies, drug trials and development, etc.

    HIV/AIDS Email List Serve and Archive:

Food Safety for People with HIV/AIDS

    United States Department of Agriculture, Food Safety and Inspection Service: A need-to-know guide for those who have been diagnosed with HIV/AIDS

Hepatitis C: Nutrition Care, Canadian Guidelines for Health Care Providers

    Dietitians of Canada

HIV and Hepatitis

HIV Guide

    Johns Hopkins University School of Medicine, its Point-of-Care Technology provides many downloadable resources:

HIV InSite

    University of California San Francisco, up to date information on treatment, prevention, and policy, ex. knowledge base, conferences, articles, links, etc:


    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Nutrition Quality of Life

    Nutrition Quality of Life Annotated bibliography:

    Nutrition Quality of Life Survey Tool:

Oral Manifestations of HIV Disease

    From a presentation by David A Reznik DDS, June 2005, International AIDS Society USA, Topics in HIV

    Medicine Volume 13, Issue 5 Dec 2005/Jan 2006. Also see:

Overweight and Obesity

    Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Renal Disease

Kidney Disease Outcome Quality Initiative (KDOQI) Clinical Practice Guidelines from the National Kidney Foundation,

    which provides information for professional and patients, and more.

     Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients: Recommendations

    of the HIV Medicine Association of the Infectious Diseases Society of America Gupta SK, Eustace JA,

    Winston JA, Boydstun II, et al. CID 2005;40:1559-1585

Ryan White HIV/AIDS Programs

HIV/AIDS Bureau, Health Services and Resources Administration (HAB/HRSA)

    HAB is the federal agency that administers the funding for Ryan White HIV/AIDS Programs, providing

    information, technical assistance and publications on funding and guidance, quality management,

    education and resources.

Medical Nutrition Therapy - Service Category Definition

    In Instructions for Completing the 2008 Ryan White HIV/AIDS Program annual Data Report, effective July

    21, 2008

Ryan White Treatment Modernization Act of 2006

    Public Law 109-415 December 19, 2006, Amends title XXVI of the Public Health Service Act

2008 Ryan White HIV/AIDS Program Data Report

    July 21, 2008

The Impact of Medical Nutrition Therapy in Ryan White Care Centers

    Jennifer Teters, Journal of the American Dietetic Association, Vol 108(7) July 2008, p.1122-24.

    Side Effects of Anti-HIV Medications: Health Information for Patients

    Treatment of Tuberculosis. Official Joint Statement of the American Thoracic Society, CDC, and the Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine

    (2003;167:603--62) and MMWR June 20, 2003/52(RR11);1-77

Young People: Nutrition and the Health of Young People

    CDC, 2005:

    Weight and Anthropometry

Anthropometry Procedures Manual

    National Health and Nutrition Examination Survey. Revised January 2002.

Body Mass Index


Growth Charts

    CDC Growth Charts, United States:

Healthy Weight Management

    Partnership for a Healthy Weight:

    Healthy Weight, Overweight, and Obesity among U.S. Adults National Health and Nutrition Examination Survey (NHANES), National Center for Health Statistics, USDHHS,


Methods of Body Composition Analysis

    Includes tutorials on underwater weighing, dual-energy x-ray absorptiometry, bioelectric impedance analysis,

    and total body electrical conductivity from the University of Vermont

National Center for Health Statistics (NCHS), NCHS en Espaniol

     Patient Weight & Nutrition Flow Sheet Last Name:__________________ First Name:________________

    I.D.#____________________________ DOB:_________________

     Date Date Date Date Date Date Date

    1 Height (inches)

     2 Weight (lbs)

    3BMI (___lbs at 22 BMI)

    % Weight change/

    in number of 4months

    5 % IBW (___lbs)

    6 % UBW (___lbs)

    7 % GBW (___lbs)

     8Waist circ. (inches)

     9BCM (lbs) (___)

     Date screened by PCP for 10Nutrition Problems

     Date nutrition Referral 11By PCP Made

     Date MNT by RD 12 Provided

     Nutrition Concerns 13Identified by PCP/RD

     1 Height: actual height taken using a stadiometer and without shoes 2 Weight: actual weight taken on a balanced scale without shoes 3 BMI (body mass index): weight in kg / height in meters x height in meters (see below for table, equations & weight categories) 4 % Weight change from last visit /number of months: actual weight / last visit weight x 100 / number of months since last visit 5 %ideal body weight: actual weight / ideal body weight x 100. IBW: use Hamwi method (see equation & weight categories below) 6 %UBW: actual weight / usual body weight x 100 7 %Goal Body Weight: actual weight / goal weight x 100 8 Waist circumference:; using NHANES method; component of metabolic syndrome when > 40 inches for men; > 35 inches for women 9 BCM: body cell mass in pounds using BIA or BIS (note which tool used) 10 PCP: primary care provider screens for nutrition related problems minimum 2/year; initials of PCP and date screened; use screening tool. 11 PCP: primary care provide refers for medical nutrition therapy: initials of PCP and date referred use referral tool mechanism. 12 RD: registered dietitian; MNT: medical nutrition therapy; at least 1-2x/yr for asymptomatic & 2-6x/yr for symptomatic patients RD; initial of RD & date completed. 13Nutrition concerns that either primary care provider or registered dietitian identifies

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