Erni Juwita Nelwan, MD, FACP, FINASIM Consultant of Tropical and

Erni Juwita Nelwan, MD, FACP, FINASIM
Consultant of Tropical and Infectious Diseases
Division of Tropical and Infectious Disease
Department of Internal Medicine
Faculty of Medicine University of Indonesia
JAKARTA
[email protected]
Erni Juwita Nelwan
Divisi Tropik dan Penyakit Infeksi
Departemen Ilmu Penyakit Dalam
FKUI / RSCM
Immunonutrisi

Intervensi nutrisi yang dapat
memodulasi sistem imun
Outline

 Pengaruh infeksi HIV/AIDS pada status gizi
 Pengaruh malnutrisi pada infeksi HIV
 Defisiensi mikronutrien pada infeksi HIV
 Komponen tatalaksana nutrisi
Metabolisme Gizi pada ODHA

Asupan gizi tidak adekuat
(gangguan kognitif/depresi,
poverty, anorexis, nausea, jamur
mulut )
Memperburuk status gizi
(Malnutrition)
Depress antibody production,
the function of phagocyte cells,
and levels of complement.

Absorption of amino acids

GIZI & HIV

Gizi
terganggu
Kebutuhan
zat gizi
meningkat
HIV
Resiko
terhadap
penyakit
infeksi
meningkat
sistem
imun
menurun
EFEK HIV PADA GIZI
Infeksi
sekunder
berulang

Anoreksi
a
Diare
berulang
Multifarmasi
Kebutuhan
energi
meningkat
Kebutuhan
nutrisi
meningkat
Malabsorbsi
HIVGIZI
Respon
peradangan
Stages of HIV Disease and
Nutrition

 Specific nutrition recommendations vary according to the
underlying nutritional status and extent (stage) of HIV
disease progression
 The disease progression may be categorized into three
stages:
 Early (I): no symptoms, stable weight
 Middle (II/III): significant weight loss
 Late (IV): symptomatic, full-blown AIDS disease
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Early Stage (I)

 No symptoms, stable weight
 Increased nutritional requirements during HIVinfection
 Energy increase: 10 - 15%
 Protein increase: ~ 50%
 Vitamins and minerals used by the immune system are also
increased
 Main objective: remain as healthy as possible
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 Build stores of essential nutrients
 Identify locally available and acceptable foods
 Maintain weight and lean body mass, preserve muscle
mass, and increase energy
 Adequate diet
 Maintain physical activity
Middle Stage (II/III)

 Significant, unintentional or undesirable weight loss
as a result of opportunistic infections
 Main objective: minimize consequences
 Increase nutrient intake for recovery/weight gain
 Maintain intake during periods of acute illness and
depressed appetite
 Increase nutrition intake gradually to promote weight
and muscle mass gain, and nutritional recovery
 Make every bite count
 Daily vitamin-mineral supplements
 Continue physical activity as able
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Late Stage (IV)

 Symptomatic, full-blown AIDS disease
 Main objective: provide comfort or palliative care
 Treat all infections that affect intake
 Modify diet according to symptoms
 Maintain intake during periods of acute illness and
depressed appetite
 Encourage eating and physical activity as able
 Provide psychological and emotional support
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HIV dan Malnutrisi

 Kejadian HIV dan malnutrisi tinggi di berbagai
negara (~ wasting)
 Malnutrisi:
 Mempercepat progresivitas infeksi HIV
 Infeksi HIV menurunkan status nutrisi
 Malnutrisi:
 Primer (intake tidak adekuat)
 Sekunder (gangguan metabolisme dan penyerapan
makanan)
Mikronutrien Defisiensi

 Banyak ditemukan pada penyakit infeksi termasuk
HIV
 Difficult to measure (hidden hunger)
 Contoh defisiensi mikronutrien:




Zat besi  anemia
Iodine  gangguan tiroid
Vitamin A
Vitamin D
REKOMENDASI GIZI

Manifestasi Klinis
Gangguan Gizi
Rekomendasi Gizi
Anoreksia
Penurunan nafsu
makan, kesulitan
menelan karena
infeksi jamur mulut
(kandidiasis oral).
makanan lunak, porsi
kecil dan sering,
minum menggunakan
sedotan.
Diare
Kehilangan zat gizi
dalam tubuh
rendah serat, lemak,
dan
banyak mengkonsumsi
cairan, buah-buahan
tinggi kalium dan
magnesium : pisang
REKOMENDASI GIZI

Manifestasi Klinis
Gangguan Gizi
Rekomendasi
Sesak Nafas
Asupan kalori tidak
mencukupi, pasien
lemah
Makanan diberikan
dalam posisi setengah
tidur
Malabsobsi Lemak
Gangguan penyerapan
lemak
sumber lemak nabati
Demam
Peningkatan
pemakaian kalori dan
kehilangan cairan
minum lebih dari 2
liter/ hari (`bb)
BB turun
Gangguan makan
secara oral
Tinggi kalori protein,
padat kalori,rendah
serat, porsi kecil
dan sering
The Vicious Cycle of
Malnutrition and HIV
• Insufficient dietary intake
• Malabsorption, diarrhea
• Altered metabolism and
nutrient storage
• Increased HIV replication
• Hastened disease progression
• Increased morbidity
Nutritional
deficiencies
• Increased oxidative stress
• Immune suppression
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Key Points

 HIV can lead to malnutrition by multiple mechanisms
 Malnutrition is associated with increased HIV
transmission, progression, and mortality
 Nutritional supplementation is associated with improved
HIV-related outcomes
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Key Points (2)

 Maintaining adequate nutrition prolongs well-being of
HIV-infected persons but is difficult
 HIV affects nutrition in three, sometimes overlapping,
ways:
 Reduces amount and type of food consumed
 Interferes with the digestion and absorption of nutrients
 Alters metabolism of nutrients
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Key Points (3)

 Counseling and other interventions to prevent or reverse
weight loss are likely to have their greatest impact early in
the course of HIV infection
 Nutritional care and support should be part of a
comprehensive program that deals with the needs of the
patient and his or her family
 Nutritional supplements, particularly antioxidant
vitamins and minerals, may improve immune function
and other HIV-related outcomes, particularly in
nutritionally vulnerable populations
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Key Points (4)

 Managing common symptoms related to HIV/AIDS such
as diarrhea, nausea, and loss of appetite, can minimize
their impact on nutritional status
 Prevention of food- and water-borne infections reduces the
risk of diarrhea, a common cause of weight loss,
malnutrition and HIV disease progression in people living
with HIV and AIDS
 Continuing physical activity and exercise, as appropriate,
increases energy, stimulates appetite and preserves and
builds lean body mass
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