Nutrition Chapter 1

1.2.1. Stage 1: Asymptomatic Phase

1.2.1. Stage 1: Asymptomatic Phase

The asymptomatic phase is the earliest stage of HIV. It develops within one to two months after the person has been infected. In this stage, the person will experience flu-like symptoms such as fever and headaches. The virus multiplies and spreads throughout the body, attacking the CD4 cells of the immune system.

During the early stages of the infection the emphasis is on a normal healthy balanced diet. Focus not on a single food, but on eating a variety of healthy foods; if you diversify your healthy meals, you stand a better chance of maintaining your health. If you eat well during this phase, you stand a good chance of postponing further development of the illness.

Even though there will be no symptoms, the infection does increase energy and nutrient requirements. Other factors such as depression, anxiety and loneliness may have an influence in the nutritional choices of the person coming to terms with their HIV status. Meeting the patient’s nutritional needs is important if the patient is to delay the onset of Stage 2.

1.2.2. Stage 2: Minor Symptomatic Phase

1.2.2. Stage 2: Minor Symptomatic Phase

In this stage the virus continues to multiply in the body, but at lower levels. People who are at stage 2 of HIV may not have any symptoms of the virus, but are able to spread the virus to other people. The HIV infection progresses to AIDS approximately 5-10 years later if the patient does not take antiretroviral drugs. The differences in the time of progression depends on age, background and overall health. The result however changes if the patient does take HIV medication.

During this stage, the patient will experience loss of appetite and he or she will also have to avoid or adjust to certain kinds of food in order to get sufficient nutrients.

After some years of HIV infection, the patient may experience certain problems including mouth infections such as candidiasis (oral thrush) and inability to eat and swallow food. The patient might also experience difficulties in absorbing nutrients even if they do not have problems with eating.

When the patient falls ill at this stage, they will experience some weight loss. Gaining weight after illness can become difficult if the patient has chronic diarrhoea afterwards. The patient will further experience nausea and vomiting due to the intake of HIV medication.

There are some practical and economical steps that can be taken to help maintain a healthy weight. Rapid weight loss will speed up progression into Stage 3 of the virus. Professional nutritional counselling can be sought from a registered dietician and a referral should be arranged, even though there is nothing significant that can be done at this stage. It is also good to get support from family and friends to help deal with the nutritional problems that happen during this stage.

1.2.3. Stage 3: Symptomatic (AIDS)

1.2.3. Stage 3: Symptomatic (AIDS)

The symptomatic stage is the final and the most severe stage of HIV infection because the patient has full blown AIDS. This occurs because HIV will have completely damaged the patient’s immune system, thus making the body incapable of fighting off opportunistic infections. Opportunistic infections are infections and infection-related cancers that occur more frequently in people that have a weak immune system. AIDS is diagnosed if the patient has a CD4 count less than 200 or if they have certain opportunistic infections.

More serious problems occur such as severe weight loss and muscle wasting leading to physical weakness and constant tiredness. The virus also affects the central nervous system, further making the patient unable to take care of himself/herself. At this stage infections are now serious. Fungi and viruses that enter the body may lead to excessive diarrhoea and eating is nearly impossible because of severe mouth infections. Gradually it becomes more difficult to feed the person food with basic feeding cutlery available in most homes.

Special liquid feeds are required due to the fact that the patient will not be able to feed himself/herself. These are available at supermarkets and pharmacies, but may not be affordable due to the depletion of finances in an attempt to manage the situation with the help of medical professionals. For example, there will be increased hospital visits. Food will be administered via naso-gastric tube feeding if eating becomes a challenge when the patient is sick.

Registered dieticians are then needed to prescribe special foods. Training is required in how to operate the naso-gastric tube feeding for the patient. At this stage, it is important to note that a referral is advised. In large government hospitals, patients may sometimes be seen by a dietician; that may not be the case in a private hospital but a referral to one may be necessary nonetheless.