Nutrition, the gastrointestinal tract and the acquired immune deficiency syndrome. Facts and perspectives

Diarrhoea and malnutrition are common findings in patients with the Acquired Immune Deficiency Syndrome (AIDS). In this disease, enteropathy leads to fat and D-xylose malabsorption and chronic non-specific inflammation of the small bowel. Moreover, gastrointestinal infection can induce severe diarrhoea. Depletion in real body cell mass, body fat content, and weight loss have been observed. Nutritional therapy is mandatory when weight loss is 10% or greater. Enteral feeding is not easily achieved. Parenteral feeding including fat as a nonprotein calorie source improves general condition. The use of intravenous fat emulsions has been hypothesized to have several beneficial effects. Fluidisation of human immunodeficiency virus membranes by lipid emulsions through cholesterol extraction could decrease the infectivity of the virus. Long term intravenous nutrition may be more than a treatment for malabsorption and depletion; it may possibly have direct pharmacological effects.     

Significance of altered nutritional status in acquired immune deficiency syndrome (AIDS)

Severe unrelenting weight loss appears to be a major component of the clinical picture seen in the patients with Acquired Immune Deficiency Syndrome (AIDS). Weight loss has been associated with a poor prognosis for AIDS patients with Kaposi's sarcoma. Strong evidence from a variety of clinical situations indicates that malnutrition per se adversely affects the cellular immune system and the susceptibility of individuals to infectious problems. In addition, weight loss of the degree commonly seen in the AIDS population places patients at risk of death because of resultant organ dysfunction. Moreover, severe weight loss may preclude recovery from infectious complications that otherwise would not represent a lethal challenge to the host. Because even appropriately directed therapies may not be successful when used in patients with severe weight loss, it is crucial to identify the mechanism of the weight loss associated with AIDS and to rapidly initiate evaluation of agents capable of altering or reversing this potentially lethal complication.     

Significance of altered nutritional status in acquired immune deficiency syndrome (AIDS)

Severe unrelenting weight loss appears to be a major component of the clinical picture seen in the patients with Acquired Immune Deficiency Syndrome (AIDS). Weight loss has been associated with a poor prognosis for AIDS patients with Kaposi's sarcoma. Strong evidence from a variety of clinical situations indicates that malnutrition per se adversely affects the cellular immune system and the susceptibility of individuals to infectious problems. In addition, weight loss of the degree commonly seen in the AIDS population places patients at risk of death because of resultant organ dysfunction. Moreover, severe weight loss may preclude recovery from infectious complications that otherwise would not represent a lethal challenge to the host. Because even appropriately directed therapies may not be successful when used in patients with severe weight loss, it is crucial to identify the mechanism of the weight loss associated with AIDS and to rapidly initiate evaluation of agents capable of altering or reversing this potentially lethal complication.     

The role of nutrition in HIV infection

Human Immunodeficiency Virus (HIV) attacks the immune system, resulting in people becoming HIV antibody positive. Under certain conditions the disease may develop, causing individuals to become symptomatic, possibly progressing to Acquired Immune Deficiency Syndrome (AIDS). People in this situation are nutritionally at risk. Appropriate dietary advice may affect the prognosis of the disease, alleviate symptoms and offer the patient active involvement in treatment. Dietitians have a very practical role to play in the management of this disease.     

Nutrition care of AIDS patients

Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss and protein depletion are commonly seen among the AIDS population. Though the relationship between disease progression and nutritional status has not been established, maintaining good nutritional status may support response to treatment of opportunistic infections and improve patient strength and comfort. Increased nutrient needs, decreased nutrient intake, and impaired nutrient absorption contribute to malnutrition in AIDS patients. Causes of decreased nutrient intake and absorption may be poor appetite, oral and esophageal pain, mechanical problems with eating, and gastrointestinal complications (diarrhea and malabsorption). Causes of these impediments to maintaining nutritional status are discussed, and suggestions to overcome them are given. Dietitians working with AIDS patients need to understand how the complications of the disease might affect nutritional status so that strategies for nutrition treatment can be developed. Nutrition care of AIDS patients requires that dietitians and their support personnel provide supportive, nonjudgmental care. The patients should be included in decision making regarding their nutrition care. Caring for AIDS patients in the community and through home care agencies represents an area in need of the expertise of a dietetics professional.     

抗HIV-1免疫基因的研究进展

人类免疫缺陷病毒1型(human immunodeficiency virus type 1,HIV -1)是艾滋病(Acquired Immune DeficiencySyndrome,AIDS)的病原体.HIV感染使人体免疫系统中最重要的CD4+T淋巴细胞减少,从而破坏人的免疫系统,最终使免疫系统崩溃,丧失对各种疾病的抵抗能力而并发多种感染和肿瘤最终导致死亡.宿主的一些抗艾滋病免疫基因如载脂蛋白B mRNA编辑酶催化多肽样蛋白3G、正常T细胞表达分泌的调节活化蛋白等在抑制HIV感染和延缓感染者疾病进展中都起着非常重要的作用.文章主要综述人体内抗HIV病毒的部分免疫基因及其作用机制.     

AIDS knowledge and attitudes among adolescents in the rural southwest.

A survey of adolescents living in rural southwestern towns demonstrated their knowledge of the basic transmission routes of Acquired Immune Deficiency Syndrome (AIDS). Nevertheless, misconceptions and attitudes, which may interfere with adopting safe behaviors, persist. Significant differences in knowledge did exist between the ethnic groups surveyed. Further, American Indian and black adolescents were more likely to express attitudinal biases against people who have AIDS. We conclude that current media efforts have been successful in communicating basic information regarding transmission, but there may exist a need for ethnically specific programs that focus on the misconceptions and attitudes surrounding AIDS.     

AIDS in the workplace: current practices and possible implications.

The testing of Acquired Immune Deficiency Syndrome (AIDS) remains a political factor. Questions are being raised as to an individual's right to privacy and the public's concern for safety. Despite the controversy, the law protects contagious disease sufferers from employment discrimination. Along with AIDS testing, drug testing remains a controversial issue. Mandatory drug testing remains in both the public and private sectors. Legislative activity in California continues to the present.     

AIDS in the Workplace

The testing of Acquired Immune Deficiency Syndrome (AIDS) remains a political factor. Questions are being raised as to an individual's right to privacy and the public's concern for safety. Despite the controversy, the law protects contagious disease sufferers from employment discrimination. Along with AIDS testing, drug testing remains a controversial issue. Mandatory drug testing remains in both the public and private sectors. Legislative activity in California continues to be present.     

Patterns of care: an analysis of the quality of nutritional care routinely provided to elderly hospitalized veterans

To assess the adequacy of the nutritional care provided, a prospective noninterventional study was carried out on 250 randomly selected patients aged 65 and over who were admitted to a Veterans Administration Hospital. Of this group, 97 patients (39%) were found to be at high risk of having clinically significant protein-energy malnutrition. In 43 cases (17%), an assessment of the patient's nutritional status was not possible because the available data were inadequate. No patient had a diagnosis of malnutrition recorded on the problem list. Only 13 percent of the high-risk patients received some form of nutrition support therapy; 10 (10%) received oral supplements, and four (4%) were started on enteral feedings. Patients who received enteral feedings experienced a high rate of complications resulting from use of the feeding tubes. Over all, none of the high risk study patients received optimal nutrition support therapy. These findings indicate that elderly patients hospitalized in the Veterans Administration hospital in this study are usually not screened appropriately for protein-energy malnutrition, the diagnosis is frequently missed or ignored, and nutrition support therapy is underutilized and often ineffectually managed.     

The spread of AIDS

At a panel on Acquired Immune Deficiency Syndrome (AIDS) and the 3rd world in January 1988, experts focused on the profound problems generated by the AIDS pandemic. The World Health Organization (WHO) estimates that 3-5 million people in at least 127 countries now suffer from AIDS and that this figure will reach 10-30 million by 2000. The disease represents a highly debilitating force, both socially and economically, even in nations able to afford the approximately $6000/patient cost per year of treating AIDS patients. Panelists suggested that this could prove devastating for the poorer nations. WHO's AIDS program, launched in February 1987, focuses on the development and support of national AIDS control programs. It now operates in 93 countries, and 34 more countries are scheduled to join in 1988. WHO has assisted another 58 countries with shortterm AIDS action plans. The US Agency for International Development has developed a 2-pronged strategy for curbing the pandemic with prevention-emphasis programs operating under WHO.     

AIDS in a Correctional Setting

This article will provide current, relevant information on human immuno-deficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the correctional setting. Issues pertinent to the correctional setting, as HIV testing and confidentiality, transmission of the HIV virus tn the correctional setting, and HIV related education will be explored. An occupational therapy program, outlining two separate programs for (1) those who are HIV positive and those who are diagnosed with AIDS and (2) those at risk for contracting the virus, will be described.     

Estimating a treatment effect in survival studies in which patients switch treatment

For disease indications such as Acquired Immune Deficiency Syndrome (AIDS) and various cancers, randomization to a pure control treatment may be scientifically desirable but not ethically acceptable. Clinicians may insist that the experimental treatment be made available, at least as a rescue medication, for all patients in the control arm. A method for estimating a treatment effect in survival data from randomized clinical trials of this type is developed under an accelerated failure time model. This approach retains all patients in the groups to which they were randomized and is not based on an ad hoc subgroup analysis. By conditioning on having observed patient switch times, this method avoids the need to model patient switching patterns in the analysis. This new approach is evaluated using simulation studies, and is illustrated through analysing data from a Medical Research Council lung cancer trial.     

Procedures for home enteral nutrition.

As emphasis on early hospital discharge increases, home tube feeding is becoming a popular method of efficiently delivering nutritional support. This paper describes the team approach to home enteral feeding practices at the Foothills Hospital in Calgary, Alberta. Three groups of patients are referred to the program: those who require tube feedings permanently as the sole means of nutrition; those who require supplementation from tube feedings; and those who temporarily require tube feeding. The dietitian selects an enteral formula suitble for the patient. Although continuous enteral feedings are generally better tolerated by patients, intermittent feedings may be more psychologically acceptable. Continuous feedings are initiated at 50 ml per hour and increased to approximately 150 ml per hour, depending upon patient tolerance and nutritional goals. Complications can result from mechanical problems (e.g. equipment failure) and metabolic/physiologic problems (e.g. constipation). A total of 35 patients have been taught the technique of home tube feeding. The program has been well accepted by patients and physicians.     

When will prevention of HTLV-III infection be possible?

Over the last five years, the pattern and prevalence of the Acquired Immune Deficiency Syndrome (AIDS) has taxed microbiologists. The disease has increasingly looked like the result of a transmissible agent which though of low infectivity, has a predilection for certain well-defined social groups. Homosexual men are among the most commonly affected but drug addicts and haemophiliacs are also at risk. The existence of the disease in central Africa suggests also that there may be a natural focus perhaps as the result of interaction between the human population and enzootic animal virus. Nevertheless, the origin of the disease remains obscure.     

彝族人群艾滋病知识行为状况分析

目的了解彝族人群艾滋病防治知识知晓情况,探索人群行为特点和影响艾滋病在该人群中流行的原因。方法对彝族人群开展问卷调查,内容包括人口学特征、生活习惯、基本卫生常识、艾滋病相关知识、态度、近期性行为、吸毒史等。结果调查对象文盲占76.0%,农民占87.5%,艾滋病防治知识知晓率不高,为50%左右,非"在婚"人群有多性伴和吸毒现象。结论彝族人群存在艾滋病传播的各种高危行为,有感染艾滋病的风险,需要采取有针对性的防治措施。     

The challenge of AIDS education for physicians.

Education has been identified as one of our best weapons in the Acquired Immune Deficiency Syndrome (AIDS) epidemic, both to help reduce the spread of the virus and to improve the care of patients with the disease. Medical educators have been asked to take on a difficult task: to assure that physicians acquire the knowledge, skills, and attitudes necessary to make them as effective as possible in dealing with the HIV infection. This article reviews some of the factors which influence the effectiveness of AIDS educational programs for physicians and some of the challenges which medical educators must face.     

Nutritional monitoring of a pediatric burn patient.

The pediatric burn patient presents a particular challenge nutritionally. Nutritional reserves are limited, and excesses are often poorly tolerated. Ongoing monitoring is essential for discovering at an early stage the dynamic shifts in energy, protein, and other nutrients that may be occurring. Adequate enteral intake may be difficult to achieve as a result of repeated holding of feedings on surgery days and gastrointestinal tolerance problems such as poor gastric emptying and abdominal distention. This case report illustrates techniques, such as the nutritional assessment record and parenteral nutrition evaluation form, which may assist the clinician in optimizing the nutritional management of the patient.     

中国艾滋病健康教育与行为干预综述

艾滋病是一种由HIV感染引起的疾病,已经流行了20多年,而且目前还没有办法对它进行根本性的治疗。预防和控制艾滋病,健康教育和行为干预是最有效的方法之一。中国是HIV检测阳性率增长最快的国家之一,正面临着全国范围内的艾滋病流行。通常情况下,多性伴者和静脉吸毒者是高危人群,他们也是健康教育和行为干预的主要人群,在多种形式的健康教育和行为干预中已经取得了明显的效果,健康教育和行为干预必须从科学事实出发,遵循一系列策略从各个方面进行执行,并要求全社会的人都来参与。