Question

Explain the rationale for using hydrolyzed formulas with HIV patients with severe malabsorption.

Answer 1

Infection caused by HIV and malnutrition have a complex interaction.Nutrition and HIV infection have a complex and dependent interaction. Gastrointestinal function and nutritional status are often affected by HIV, its secondary complications, and by therapies.Proper nutrition also directly affects immune status, moderates the efficacy of medications, may reduce the severity of side effects, and can affect important outcomes, including quality of life and productivity

HIV infection has many nutritional effects. These include an increase in resting energy expenditure especially with opportunistic infections, decreased dietary intake, neuropsychologic effects (e.g. depression), anorexia, malabsorption especially with infections of the gastrointestinal tract.

Here we are discussed about malabsorption with HIV patients. the main reasons are, The small intestine is a major target in HIV infection. Chronic diarrhoeal disease associated with malabsorption is the principal clinical manifestation of such infection. Reduced intestinal immunity and opportunistic enteric infections play a major role in clinical disease, but an enteropathy induced by HIV per se has also been implicated. The immunopathology of reduced intestinal immunity and its progression during HIV infection is poorly understood. HIV genome and proteins have been detected reproducibly in cells of the lamina propria resembling macrophages, but direct epithelial infection with HIV is controversial. Another factor which may contribute to diarrhoea is autonomic neuropathy within the jejunum. Small intestinal disease causes malabsorption of fat and disaccharides and may contribute to the weight loss seen in advancing HIV infection. However, malnutrition seen in HIV infection is multifactorial and may occur as a constitutional sign of infection in the absence of overt intestinal disease. Reduced food intake does not appear to be a causative factor in the weight loss in constitutionally well stage IV patients and there is some evidence that release of cytokines into plasma or locally into tissue may mediate such events. The response of HIV infected individuals to nutritional support is variable, but it is becoming increasingly apparent that the response is limited by the presence of severe systemic infection. However, aggressive nutrition is an important therapeutic mode which should be offered to all HIV infected patients