Symptoms that affect the whole body, or constitution, are called constitutional symptoms. Constitutional symptoms include fever, night sweats, weight loss, fatigue, lethargy, and malaise. All these symptoms are relatively common both in the general population and in people with HIV infection. People with HIV infection tend to have constitutional symptoms when the CD4 count is low, unless the people are also depressed or have some unrelated medical problem like influenza. Some of these symptoms—fatigue, lethargy, malaise—are subjective and difficult to measure. Others—fever, severe weight loss (wasting)—are more objective.
Wasting is the somewhat unfortunate term given to unintentional weight loss. Wasting that results in the unintentional loss of 10 percent of the body weight, with no explanation other than HIV infection, is now accepted by the Centers for Disease Control as an AIDS-defining diagnosis.
People with HIV infection lose weight for different reasons: difficulty eating, lack of appetite, apathy and depression, prolonged diarrhea, nausea and vomiting, HIV itself, opportunistic infections that affect various organs of the body, and fever. Fever can contribute to wasting because fever increases the rate at which the body metabolizes food by 7 percent for each degree F: a person with a temperature of 103 degrees F through the day will have a metabolic rate that is increased by 30 percent. Wasting is commonly accompanied by protein-calorie malnutrition.
Treatment of wasting depends on the cause. If the cause is difficulty eating, the sores and ulcers that cause the difficulty should be treated with drugs, and the person should eat foods that are soft, easy to swallow, and bland. If the cause is lack of appetite, appetite stimulants like Megace might help, and the person should eat foods he or she likes. If the cause is apathy, the caregiver needs to encourage the person with HIV infection to eat, and a stimulant like Ritalin might help. If the cause is prolonged diarrhea, the infection causing diarrhea should be treated with drugs; the diarrhea itself can also be treated with drugs like Lomotil, loperamide, or paregoric. If the cause is nausea and vomiting, the person should eat small meals frequently, avoid aromatic foods, and eat food that is easily digested; nausea and vomiting can also be treated with drugs. If fever is a factor in wasting, treatment will try to reduce fever with aspirin, acetaminophen, or ibuprofen and will try to eliminate the cause of the fever.
In general, cater to individual tastes, eat small and frequent meals, and eat food that contains a lot of calories and protein. For the short term, anyway, don’t worry too much about a balanced diet and eat snack foods that carry large numbers of calories: peanuts, peanut butter, nuts, raisins, sunflower seeds, M&Ms, Oreo cookies, pizza, milkshakes, potato chips, Fritos, macaroni and cheese, Big Macs, most candy bars, fudge sundaes, marshmallows, and many others. Try asking a licensed dietitian.
When people cannot eat enough to compensate for losses, supplements will help. Supplements like Ensure, Sustacal, Enrich, and Magna-cal (approximately $1 per can) are rich in calories, complex carbohydrates, and fat. The various supplements are similar in nutritional value. They are available in grocery stores and pharmacies. If the supplements are taken in addition to meals, the person will need a few cans a day. If the supplements are the only nutrition the person is getting, the person will need about ten cans a day.
When people have problems that prevent the small intestine from absorbing food, different supplements which are predigested and ready to absorb will help. Supplements like Vivonex T.E.N, cost about $6 to $8 per can. If these supplements are taken in addition to meals, people will use three to six cans a day; if the supplement is the only source of nutrition, the person will need six to nine cans a day.
All nutritional supplements are available without prescription. But if a prescription is written nevertheless, Medicaid and some insurance plans will cover the supplement’s cost.
On the rare occasions when the intestines quit digesting and absorbing food, nutrients might need to be provided by vein—a procedure called parenteral (meaning by vein) hyperalimentation. Most physicians prefer to use parenteral hyperalimentation for only a week or two to get past a temporary problem, though occasionally they use it for longer periods.
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