• Encourage patients to eat what they like, aiming for a high-calorie/high-protein diet.
• Avoid high-fat foods.
• Don't wait for weight loss to start nutritional supplementation.
• Maintain hydration and promptly treat fevers, infections and diarrhea.
  • 9-12 (8 oz) cups of water per day.
• Vitamin supplementation 2X daily recommendation for water soluble vitamins.
• With diarrhea, use frequent small meals and avoid extremes in temperature and fat content.
• Be attuned to the possibility that depression can serious complicate matters and lead to reduced food intake.

So what became of Mr. Abrahms? Remember his SGA score?

• His oral Candidiasis quickly responded to therapy and he is able to eat pain-free.
• His triple drug anti-retroviral regimen has begun to work and his CD4 count is rising.
  • His lipids will be monitored and he will likely need treatment for hyperlipdemia.
• A consultation visit with the dietitian went well, and she recommended:
  • Vitamin and caloric supplementation until his weight comes back to normal.
  • Adjust his daily protein intake to 2-2.5 g/kg
    • Threonine and methionine are limiting amino acids for protein synthesis in AIDS patients.
  • Maintain his caloric intake at 35-45 kcal/kg
  • Be prepared to increase daily calories by 1.5X during times of infection.
  • He will be seen again in 6 weeks for a follow-up visit.
• He has agreed to see a psychiatrist who can help with his depression.

Mr. Abrahms says he now has a positive outlook and is hoping he can go back to work.

Ready for a step back in time?