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Position Paper Summary on the Position of the American Dietetic Association: Nutrition
Intervention and Human Immunodeficiency Virus Infection

Lorraine Bonkowski
NFS 4950: Senior Seminar
February 2, 2015

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The position paper I chose was on Nutrition Intervention and Human Immunodeficiency
Virus Infection. The position states, It is the position of the American Dietetic Association that
efforts to optimize nutritional status through individualized medical nutrition therapy, assurance
of food and nutrition security, and nutrition education are essential to the total system of health
care available to people with human immunodeficiency virus infection throughout the continuum
of care. This position was in affect until December 31, 2014. The authors of the paper are Cade
Fields-Garnder and Adriana Campa 1.
It is estimated that 1.2 million people in the United States and 35 million people
worldwide are living with human immunodeficiency virus (HIV). HIV, if left untreated, can
progress to acquired immunodeficiency syndrome (AIDS) which causes the body to have a
severely damaged immune system, making it unable to fight diseases, which can eventually lead
to death. However with the help of antiretroviral therapy (ART), a treatment using HIV
medications, one is able to keep the HIV virus level low and prevent the progression to AIDS2.
Along with ART, nutrition plays an important factor in maintaining good health and quality of
life for HIV patients. The Academy feels that it is important to increase the efforts of nutritional
healthcare available to people with HIV as part of their total health care system. They hope to
increase the nutritional status of those infected through the help of medical nutrition therapy,
decreasing food insecurity and providing more education on nutrition.
The Academys position states the necessity for people living with HIV to have
individualized medical nutrition therapy. This means that each HIV patient should have a diet
assigned to them based on their specific needs. Death rates are higher in HIV patients with
malnutrition, even in those receiving ART. Children are especially at a high risk for malnutrition

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because of their extra demands with growth and development. A person living with HIV that is
well nourished is more likely to delay the diseases progression to AIDS, better handle the effects
of the infection, and improve their longevity1. A beginning assessment of nutrition status should
be performed for clients with HIV as well as continued follow up assessments to provide the
client with a proper nutrition care plan. An assessment can be done using the ABCD evaluation
which includes anthropometric, biochemical, clinical and dietary measures. Having a baseline
assessment is important for keeping track of the patients decline or improvement of health. This
is helpful in watching for problems such as AIDS-related wasting syndrome which is a 10% loss
of weight from the baseline measurement within six months, along with diarrhea, fever, and
weakness. It is also important to watch for shifts in nutrient levels during various stages of the
disease in order to determine a proper diet. Micronutrients and macronutrients such as iron,
selenium, zinc, B-12, carbohydrates and fat can fluctuate depending on if the patient is showing
symptoms or is asymptomatic. Protein is an important macronutrient in maintaining proper body
functions such as immunity1. For someone that is already immunocompromised and has trouble
maintaining an overall energy balance, balancing this nutrient is essential to their health.
Healthcare professionals also need to base nutrient therapy off of the medications the patient is
receiving. Certain nutrients can affect the absorption, usage, and side effects of medications.
Providing medical nutrition therapy needs to be individualized for every patient with HIV since
the dietary needs can vary depending on several different variables.
Another part of the Academy's position is to optimize nutritional status by addressing the
issue of food and nutrition insecurity. For many living with HIV, they also face economic
insecurity, being viewed as outcasts, institutionalization, drug use or other diseases. Food

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insecurity and hunger are sometimes a result of these additional issues. Food insecurity can then
lead to bad behaviors that increase the risk of exposure and transmission of HIV. It can also lead
to a decrease in treatment effectiveness and weaken the progress of programs aimed at improving
health. According to a United Nations Policy Brief, it was said that food availability and proper
nutrition are essential for keeping people living with HIV healthy for longer1. For people already
dealing with HIV, having these available helps to prevent other harmful infections such as
tuberculosis. Food insecurity essentially then leads to malnutrition, which as discussed
previously can impair the overall health of HIV patients. The Academy believes that providing
nutrition security worldwide is an important part to providing a total system of healthcare to
those with HIV.
The Academy also hopes to increase nutrition education for people living with HIV. This
is important for the patient in order to help manage their condition when not under surveillance
of a healthcare professional. There are several topics that are important for HIV patients to be
educated about. One of them is learning about the stages from pregnancy to raising a child while
dealing with HIV. This topic covers issues such as the transmission risk of HIV during
breastfeeding, proper nutrition during pregnancy and lactation, and growth development in
children. Another topic is lifestyle which educates patients about basic nutrition, physical activity
and body image. Under the topic of nutrition interactions, patients learn about the interactions
between nutrients and medications, supplements, alcohol, and recreational drugs. The final topic
of education is life skills and socioeconomic issues which relates to food and water safety, food
preparation skills and also how to deal with food insecurity1. A good example with educating
HIV patients involves food borne illnesses. Those living with HIV are more susceptible to food

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borne illness and therefore educating them on something as simple as food safety will promote a
healthier lifestyle. Counseling is also an important part of education, for example showing a
patient how to develop meal plans in coordination with taking their medications. By providing
education to those with HIV, the Academy hopes to enhance their nutritional status.
A registered dietitian or nutrition professional has many roles in order to maintain an
optimal nutrition status for HIV clients. They should educate the clients and their caregivers
about the importance of nutrition to maintain health but also the possible interactions that
nutrients can have on medications, supplemental nutrients, herbs, and therapies. They should
perform assessments of the clients nutritional status regularly to update the proper medical
nutrition therapy and strategies for the client. This includes nutritional strategies for managing
disease and medication side effects such as nausea, vomiting, diarrhea, glucose intolerance and
insulin resistance. It is important also for registered dietitians to keep updated on the research
involving both nutrient and non-nutrient based treatments and supporting any medical treatment
of HIV. Another role is to keep informed about any programs that could benefit the client if they
have social, economic, or psychological needs. One last role dietitians need to keep in mind is
offering the client personalized care, abiding by privacy rules, where they feel no judgement1.
I agree with the position of the Academy. I believe very strongly in medical nutrition
therapy and the idea that nutrition helps to heal the body. Of course I also believe that the
intervention of modern day medicine is important, especially in severe health issues such as
human immunodeficiency virus. I think it is good to keep in mind that medicine and nutrition
can go hand in hand. A sick patient could be receiving the best medicine available but if they do
not acquire the proper nutrition to provide the body with the right nutrients, the medicine will be

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useless. The position paper states that death rates are higher in HIV individuals that are
malnourished, including the ones that even receive ART1. I also agree with having assurance of
food and nutrition security for those with HIV. Those with food insecurity are at higher risk then
of malnutrition leading to mortality. I think that nutrition education is very important for those
living with HIV. Learning topics such as nutrition principles, physical activity, water supply
safety, and food hygiene will help them maintain an overall better idea about health and how to
manage it while living with HIV. I think nutrition education is especially important for mothers
with HIV and for parents with an HIV positive child. The position paper mentions the possibility
of mothers passing HIV to their offspring. Women need to be informed about the proper nutrition
during pregnancy and the transmission risk during breastfeeding. Parents need to be aware that
children with HIV are at an even higher nutritional risk and learn the steps in avoiding
malnutrition. With the Academys position on nutrition intervention and HIV, I think that we are
taking a step in the right direction help those with HIV to have a better quality of life and to
ultimately prevent more cases of HIV and the progression to AIDS.

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References
1. Fields-Gardner C, Campa A. Position of the American Dietetic Association: Nutrition
intervention and human immunodeficiency virus infection. Journal of the American Dietetic
Association. 2010; 110: 1105-1119.
2. What is HIV/AIDS? aids.gov Web site. Available at: https://www.aids.gov/hiv-aids-basics/
hiv-aids-101/what-is-hiv-aids/. Accessed January 30, 2015.