Connect with a Support Group

A great support group for HIV positive patients (Wasting Syndrome falls under HIV) that is available online is called HealthUnlocked, this is the link to it- https://healthunlocked.com/hivpartners.

 This website gives HIV patients the opportunity to ask questions, look for advice, connect with other HIV patients, and with the organization’s help find a local support group within their own community. This organization is also connected with HIV i-Base, Positively UK and Forum Link.  

HealthUnlocked is in a blog format where anyone can post questions, concerns, and answers to other questions. I find this a great way to start for patients diagnosed with HIV and any following syndromes or opportunistic infections due to HIV. First of all, it is available to everyone and it is really easy to find (online), secondly this organization doesn’t leave patients with only blog posts and answered questions, but they help those patients to connect within their own community.

Another support group that is available http://hiv.supportgroups.com/ (Link), simply connect patients with HIV where they just talk about daily life things, and talk to each other via blog posts.

Another great support group is called experience project. Here is the link to it http://www.experienceproject.com/groups/Am-HIV-Positive/19015. It also has posts, but another great thing about it is there are groups which you can join based on your need, for example some of the groups are “I want to start a new life”, “I feel like I don’t belong in my family”, “I am more of a suffer in silence type”, and many more. There is also the opportunity to connect with people you find similar to you or would like to talk personally.

There are many support groups online, majority of them are similar in that you get to connect with other patients and just talk to them. Also get your questions answered, and keep on living knowing that someone is going through the same thing as you are and they understand you and are there to help you.

 

 

 

 

 

Recovery Record Clinician (for Eating Disorder Treatment Professionals)/ Recovery Self Record App

Recovery Record Clinician (for Eating Disorder Treatment Professionals)/ Recovery Self Record App

 

Recovery Record Clinician (for Eating Disorder Treatment Professionals)/ Self Record App is one of many apps I would recommend to patients with Wasting Syndrome. First of all patients are able to watch their diet by recording what they eat and how they feel about it on Recovery Self Record. On top of that, their physician or nutritionist is able to connect with them by using their Recovery record Clinician app, thus connecting with their patients and monitoring their health. Using this app, the physicians/nutritionist are able to write out meal plans for patients to follow, reminders, clinical goals, and view graphs that interpret data. Patients at the same time record their data, read recommendations from their physician, view their improvements and things they need to work on. Patients and their physician/nutritionist are able to communicate through this app and keep a close record of their diet.
This app would be very useful for nurses as well, since they would most often evaluate the patient's records and report for abnormalities.

 

Website Recommendation

Most appropriate care for Wasting Syndrome patients would be a nutritionist and a physician, since wasting is a problem that directly relates to nutrition. Only in severe cases the patients would need the care of a nurse, where they would be required to stay in special facilities because they no longer are able to take care of themselves. In such cases most often they would be fed through a tube and wouldn’t be able to accomplish daily life activities.

For a nurse that is taking care of a patient with Wasting Syndrome, the knowledge of the disease would be essential. A website I would recommend to nurses who are taking care of patients with Wasting Syndrome, although not most recent (2003), but includes all the main points that are needed to have a good idea about it. Link to this website is- http://hivinsite.ucsf.edu/InSite?page=kb-04-01-08.

This website includes the basics, pathophysiology, evaluation of wasting, interventions of wasting, pharmacological treatment, and exercise. All of these points are broken down and explained in detail. The information is trustworthy, gotten from University of California, written by Kathleen Mulligan (PhD), Morris Schambelan (MD).

Nurses can rely on the details of treatments and medications and reasons for giving the medications. The article is a summary of a study that brings out the importance of different treatment methods, and possible side effects.

It is a great website to get an overview of the entire process of wasting and steps that can be taken to prevent or improve the condition.

 

 

 

Nutrition for Wasting Syndrome of HIV Patients

For a patient diagnosed with HIV wasting syndrome it is very difficult to maintain advised nutritional intake. First of all because of repetitive nausea and diarrhea one may feel better not to eat at all than suffer such outcomes, also many medications and treatments are really strict about the times and portions a patient may eat. Some drugs may react with the food causing undesirable side effects, thus the patients must be educated about exact times they may eat and certain types of foods to avoid.

According to New York State Department of Health AIDS Institute the advised (2004) “proportion of macronutrients should approximate 50% to 55% carbohydrates, 15% to 20% protein, and 30% fat.” If comparing to a non-HIV patient recommended American diet the protein proportion is higher because of the lean body mass loss the patients with HIV Wasting Syndrome suffer from.  

Also “clinicians should recommend the use of “once daily” multivitamin supplements containing selenium (20-40 mcg) for all HIV-infected patients experiencing weight loss” (New York State Department of Health AIDS Institute the advised, 2004).

Patients diagnosed with wasting syndrome of HIV should eat multiple small portions throughout the day. Due to vomiting and diarrhea associated to wasting syndrome, patients are recommended to maintain high caloric diet with more protein than a healthy person would need. Reasons to that are because of diarrhea and vomiting the body isn’t able to absorb the amount of nutrients needed resulting in malnutrition. The consequences are also one will not absorb enough vitamins needed to keep the body in good working condition.

In summary, patients with Wasting Syndrome of HIV should maintain their high caloric intake by eating small meals throughout the day. They should eat more protein then healthy people are recommended, and take multivitamins.

 

 

 

 

 

 

References

New York State Department of Health AIDS Institute. (2004). General Nutrition, Weight Loss, and Wasting Syndrome. HIV Clinical Resource. Retrieved from http://www.hivguidelines.org/clinical-guidelines/adults/general-nutrition-weight-loss-and-wasting-syndrome/

HIV Wasting Syndrome Treatment

 

Initial treatment for HIV Wasting Syndrome includes nutrient intake of at least 100% of the Recommended Dietary Allowance, supplemented with vitamins. Also appetite stimuli treating anorexia, include Marinol (synthetic derivative of marijuana) which also may decrease nausea and improve mood, and synthetic progestational drug (Megace) contributing to weight gain and appetite (Mulligan & Schambelan, 2003). Another great technique to maintain muscle mass is daily exercise.

                In case Wasting Syndrome progresses and diarrhea is preset - “balance must be found between controlling symptoms with a low-fat diet and maintaining caloric intake with fat-containing foods that offer caloric density appetite” (Mulligan & Schambelan, 2003). Dietary and supplemental fibers may aid in water binding, thus reducing diarrhea.

                In case of worsening, or failure to improve the condition with oral intake, “enteral alimentation should be initiated” (Mulligan & Schambelan, 2003). In severe cases percutaneous endoscopic gastrostomy (PEG) feeding tubes are advised since have been proven to be effective.

                Lastly, parenteral nutrition which is getting nutrients to the body through veins, is only for most severe cases of intestinal dysfunction (ex: severe/large volume diarrhea).

Since the treatments for Wasting Syndrome in HIV don’t include antibiotics or strong medications, there aren’t many side effects to them. Only for feeding tubes may be cases when it is contraindicated.

 

 

                                                                           Williams, B., & Waters, D. (1999).

 

 

 

References

Mulligan, K., & Schambelan M. (2003). HIV-Associated Wasting. Retrieved from http://hivinsite.ucsf.edu/InSite?page=kb-04-01-08#S2X

Williams, B., & Waters, D. (1999). Evaluation and Treatment of Weight Loss in Adults with HIV Disease. American Family Physician, 60(3), 843-854. Retrieved from http://www.aafp.org/afp/1999/0901/p843.html

Signs and Symptoms of HIV associated Wasting

 

                                                                           E-Mediccal (2012)

Some of the early signs of Wasting Syndrome in HIV patients is lack of interest to food, no energy to do any activities, and feeling full with a small meal. With the treatment HIV patients undergo, and the medications they take often results in side effects such as the ulcers in the mouth, and nausea making it difficult to eat or simply enjoy meals.

Other signs include early vomiting, anorexia, and diarrhea. Usually diarrhea is associated with malnutrition and is the most obvious sign of wasting syndrome. Anorexia typically results from lack of eating that is an outcome of multiple case specific factors. Early signs of vomiting are also really strong indicators of Wasting Syndrome in HIV patients since it not only signals the condition but also transitions into a condition defining wasting.

HIV patient may also be leading a sedentary life style or is in depression. Often when an HIV patient is not exercising, he/she may lose muscle due to antiretroviral medications that may take away from muscle mass.

Another possible sign of Wasting Syndrome is the progression of HIV itself. Often, when HIV progresses and opportunistic infections weaken the immune system of the patient, it often may lead to Wasting Syndrome.

Symptoms such as vomiting and diarrhea indicate progression and are most uncomfortable. As wasting develops and progresses the signs and symptoms don’t change but do progress and pick up speed.  

 

 

References

Woolard, S. (2001). Wasting Syndrome in HIV/AIDS Patients. Advance Newsmagazine. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/article/wasting-syndrome-in-hivaids-patients.aspx?CP=2

Epidemiology of HIV- Wasting Syndrome

 

                A study- Nutrition for Healthy Living (NFHL) that has been done in Boston, US from 1995-2005 looked at 881 patients with HIV around age 40; 29% were women and 44% were non-white race. In this study some of the symptoms and causes of HI-wasting syndrome were identified. Causes that fell into two possible groups: 1) inadequate nutrient intake, and 2) altered nutrient metabolism were socioeconomic status, access to care, cultural practices, psychological factors, and medical complications of therapies.

Symptoms included inadequate nutrient intake, oral and gastrointestinal symptoms, anorexia, psychosocial-economic symptoms, malabsorption, uncontrolled HIV infection, and metabolic demands of HAART (highly active antiretroviral therapy).

33.5% of the 881 HIV infected patients met the criteria of either having 1) loss of more than 10% of body weight, 2) loss of more than 5% of body weight that was sustained for longer than 6 months and lastly 3) had a BMI (body mass index) of less than 20 (normal BMI range: 18.5-25.0).

The study showed that more men than women had diarrhea, and women showed greater deficiencies in vitamins A, C, E, and B₆.  38.4% women had insufficient caloric intake. 11.3% had inadequate protein intake, 36.1% weren’t sure where they were going to get their next meal from, and 8% identified themselves as hungry.

 

 

 

 

 

 

 

Reference

 

Mangili, A. M. Zampini, D. H. Murman, & C. A. Wanke (February 7, 2006). Nutrition and HIV Infection: Review of Weight Loss and Wasting in the Era of Highly Active Antiretroviral Therapy from the Nutrition for Healthy Living Cohort. Invited Article, CID 2006; 42, 836-842. Retrieved from http://cid.oxfordjournals.org/content/42/6/836.full.pdf+html

Pathophysiology of Wasting Syndrome (HIV)

 Emedicine Cancer, (2013)

According to Mulligan and Schambelan- “factors that have been demonstrated or hypothesized to contribute to wasting include metabolic alterations, anorexia, malabsorptive disorders, hypogonadism, and excessive cytokine production” (Mulligan & Schambelan, 2003). Since for every patient with HIV Wasting Syndrome the reason is different we need to take in consideration that the factors causing the syndrome are interdependent and aren’t always as easy to sort out.

                The first cause to HIV Wasting Syndrome is metabolic alternation. Most common contributing factor to wasting has been decreased energy intake. Also their total energy expenditure (amount of energy (calories), that a person uses to breathe, circulate blood, digest food, and be physically active) is often decreased while their resting energy expenditure (amount of calories required for a 24-hour period by the body during a non-active period) is increased correlating with decreased physical activity levels (Mulligan & Schambelan, 2003).

                Another contributing factor for wasting is anorexia; which also is affected by other factors. Possible causes for anorexia are painful oral and esophageal problems, altered taste perception, and nausea from medications. As well as restrictions from food at given times for antiretroviral treatments, lack of interest for food due to social isolation, depression, and fatigue.

                Malabsorption and diarrhea are also strong contributors for Wasting Syndrome of HIV and are common in patients that have wasting. In the study done by Schambelan and others, data shows that 50% of patients with advanced HIV had chronic diarrhea (Mulligan & Schambelan, 2003). With constant diarrhea not only does the patient not absorb the nutrients from foods eaten, but also feels discouraged to eat more when the result is evident (diarrhea).

                Another common finding in HIV Wasting Syndrome men patients was significantly decreased levels of testosterone. Although the levels of testosterone as proposed in the study may be decreased due to medications (Mulligan & Schambelan, 2003), but the fact that testosterone is responsible for body mass suggests that low levels of it may contribute to loss of muscle mass which is also a component of wasting syndrome.  

                Although there has not been enough study done on cytokine levels in HIV patients, but a common finding in those patients is elevated levels of cytokine production.

                Common factors contributing to progression include severity of HIV, low nutrient intake, no exercise, diarrhea (common in all HIV patients), and no availability to treatment and medications.

                Typically the progression of the disease, is losing weight and muscle mass, which can later be fatal. Another factor that plays a big role in progression of HIV Wasting Syndrome are opportunistic infections that occur due to weakened immune system.

 

 

References

Mulligan, K., & Schambelan M. (2003). HIV-Associated Wasting. Retrieved from http://hivinsite.ucsf.edu/InSite

What is Wasting Syndrome

Today’s topic of discussion is weight loss. Although many of you may think about the perfect body, healthy weight, and high self-esteem, the weight loss I will talk about is the HIV Wasting Syndrome.

It is the involuntary weight loss; despite the person's desire to keep their healthy weigh, they still lose more than 10% of their body weight (Stedman's, 2015).

It is when a patient has severe diarrhea, fever and weakness. They often lose much of their muscle mass, thus ending up in a more vulnerable state than they already were. Most effective treatment for HIV Wasting Syndrome is the Antiretroviral Therapy. In addition one can keep a healthy diet recommended for the HIV Wasting Syndrome patients by eating foods that are high in protein and exercise to slow down deterioration (Susa Coffey & Ian McNicholl, July 30, 2015).

Since Wasting is a syndrome of HIV, the best way to prevent it is by preventing HIV. Another possible way to prevent Wasting Syndrome is like mentioned earlier to maintain a good diet.

An image bellow is one of the cases of Wasting Syndrome with a failure of Antiretroviral Therapy in Nigeria (Ogoina D, 2010). Some of the causes of the syndrome include an inefficient food intake, vomiting, depression, and getting 'full' too quickly (Office on Women's Health, July 1, 2011).

 



Ogoina D, 2010

“A retrospective observational study was conducted using a large, geographically diverse US managed care population to identify commercial enrollees with HIV/AIDS from 1/1/2005-7/31/2007” (Siddiqui J, Phillips A. L., Freedland E. S., Sklar A. R., Darkow T., Harley C. R., May 2009). The study showed that approximately one out of ten patients with HIV have the Wasting Syndrome, it occurs more often among men than women, and to patients that are older (Siddiqui J, Phillips A. L., Freedland E. S., Sklar A. R., Darkow T., Harley C. R., May 2009). The HIV Wasting Syndrome is something one would not be able to live comfortably with, but more like in constant distress and agony.  

                                                                                                                                  

 

 

 

 

Reference:

 

Coffey S. & McNicholl I. (2015). HIV wasting syndrome. U.S. Department of Veterans Affairs. Retrieved from http://www.hiv.va.gov/patient/diagnosis/OI-wasting-syndrome.asp.

Ogoina D. (2010). HIV Wasting Syndrome in a Nigerian Failing Antiretroviral Therapy: A Case Report and Review of the Literature.US National Library of Medicine National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21209738.

Office of Women's Health. July 1, 2011. HIV Wasting Syndrome. Office on Women's health, U.S.     Department of Health and Human Services. Retrieved fromhttp://womenshealth.gov/hiv-aids/opportunistic-infections-and-other-conditions/hiv-wasting-syndrome.html.

Stedman's, Lippincott Williams & Wilkins. 2015. Definition: 'Wasting Syndrome'. Retrieved from https://www.blogger.com/blogger.g?blogID=1545003524718780037#editor/target=post;postID=1760980936468748366

Siddiqui J, Phillips A. L., Freedland E. S., Sklar A. R., Darkow T., Harley C. R., (2009). Prevalence and cost of HIV-associated weight loss in a managed care population. US National Library of Medicine National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19364303.