CLINICAL CASE STUDY Edwin is a 42-year-old male who has been HIV+ for 20 years.
ID: 127859 • Letter: C
Question
CLINICAL CASE STUDY Edwin is a 42-year-old male who has been HIV+ for 20 years. His viral load is undetectable and his CD4+ count is 643. His current HIV antiret roviral regimen is raltegravir (Isentress), atazanavir (Reyataz), ritonavir (Norvir), and emtricitabine (Emtriva); he also takes atorvastatin (Lipitor) and ranitidine (Zantac). His height is 5'9" and his weight is 188 lb. His fasting lipid profile shows a total cholesterol 184 mg/dl, triglycerides 304 mg/dl, high-density lipoprotein 25 mg/dl, and low-density lipoprotein 96 mg/dl. Since his last visit 6 months ago, he has noticed changes in his body composition including loss of buccal fat and increasing abdominal girth. Edwin lives by himself and doesn't like to cook; he also receives one meal per day from a community program. He walks for 30 minutes daily. Upon taking a 24-hour recall, you find his caloric intake to be 2700 kcal/day Nutrition Care Statements Excessive dietary intake caused by frequent intake of prepackaged meals as evidenced by diet history. NB-1.7 Altered nutrition laboratory values as evidenced by results of lipid profile assessment. NC-2.2 by increased abdominal girth. NC-3.4 Nutrition Care Questions 1. What factors may be contributing to the body shape changes that 2. What nutrition and lifestyle interventions would you recommend to 3. What are some biochemical and nutritional parameters you would Unintended body composition change of increased adiposity as evidenced Edwin is experiencing? address his nutrition diagnoses? monitor to determine whether the nutrition interventions are effective? whether they have been met? ommendations do you suggest for these symptoms? Are there any 4. How would you evaluate the desired nutrition outcomes to determine 5. Edwin has also been complaining of nausea and diarrhea. What rec- drug-nutrient interactions of which you need to be aware?Explanation / Answer
1. Factors contributing to Body shape changes in Edwin:
The person with HIV taking ART for a longer period of time experience some changes in the body shape and appearance which is called " lipodystrophy'.
Lipodystrophy symptoms lead to changes in the body metabolism. It is associated with fat loss (lipoatrophy) and fat gain (lipohypertrophy) in the body parts.
Lipohypertrophy: Some of the antiretroviral drugs alter the function of enzymes which result in the gain of visceral fat in the gut. This will increases the cholesterol and triglyceride level.
Lipoatrophy: Some of the ART therapy especially old nukes damage the fat cells especially wasting of subcutaneous tissue in the face.
2. Nutrition and Lifestyle interventions:
Nutritional support should be initiated by considering weight and anthropometric measurements. In addition, assist the patient in purchasing or preparing of food.
DIET:
The body shape changes due to lipohypertrophy can be altered by changing diet low in carbohydrates, and saturated fat. Instruct the patient to avoid intake of prepacked meals and advise to low intake of simple sugars and saturated fat. Weight reduction should be obtained gradually to avoid weight loss disproportionately. Nutritional supplements of micronutrients are recommended. Diet counseling should be given regularly.
EXERCISE:
Regular exercise is followed to avoid fat accumulation and at the same time ratio of the muscle of fat should be maintained. Moderate exercises are recommended in order to avoid changes in buccal fat.
3. Biochemical and Nutritional Parameters:
Anthropometric Measurements: Weight, BMI, waist circumference, Hip circumference, weight: hip ratio.
Lab investigations :
To assess the General Nutritional status: serum protein, serum albumin, lipid profile and immunological parameters. Special lab investigations include serum iron, vitamin levels, minerals, fasting glucose and renal function.
4. Evaluation of Desired nutrition Outcomes:
The nutritional outcomes can be evaluated by the following things:
5. Recommendations for Nausea:
Recommendations for Diarrhea:
The reason for nausea and vomiting in Edwin is due to direct effect of HIV on the cells lining the intestines. The causative organism includes cryptosporidium Muris, Salmonella species, CMV, Clostridium difficle and Giardia Lamblia.