A service evaluation to determine the effectiveness of current dietary advice in treating human immunodeficiency virus‐associated weight loss and to highlight potential service improvements

Background: Weight loss and muscle wasting are experienced by many patients with human immunodeficiency virus (HIV) (Grinspoon et al., 2003). Malnutrition is an important predicator of morbidity and mortality; people who are malnourished who received antiretroviral treatment are six times more likely to die than those who are adequately nourished (Paton et al., 2006). The physical manifestations of muscle wasting can have significant psychosocial implications for HIV patients (Power et al., 2003; Sattler, 2003). The aim of this study to evaluate provision of dietetic care to patients referred for acute weight loss advice and identify areas for potential service improvement. Methods: The data were gathered from the departmental dietetic activity statistics in 2007, diagnosis code ‘HIV – acute weight loss’. Fifty‐nine cards were located and baseline weight, height and body mass index (BMI) were recorded (two female, 57 male). Qualitative data on dietetic intervention were extracted from record cards – little and often eating approach, food fortification (FF), high energy high protein oral nutritional supplement (ONS) prescribed. Data were collected on body image, exercise and weight at follow‐up visits during 2007. Results: Forty‐three percent of the patients referred for ‘HIV‐acute weight loss’ were lost to follow‐up. Forty‐seven percent of the remaining patients had a BMI <20 kg m−2. Following their initial dietetic intervention, 81% of these patients had gained weight at the first follow‐up. All had received nutritional counselling on little and often eating approach and FF; 75% had ONS prescribed. Average weight gain with nutritional counselling alone was 1.3 kg (2.1 kg) and for nutritional counselling plus supplementation was 2.1 kg (1.8 kg). This represented 2.5% (4.1%) and 3.9% (3.4%) weight gain, respectively. Discussion: This evaluation has highlighted that patient follow‐up frequency is an area for service improvement. Fifty‐three per cent of patients (excluding those lost to follow up) had a BMI ≥20 kg m−2 and were inaccurately recorded in the statistics as being referred for ‘HIV‐acute weight loss’. Fifty‐two percent of these patients reported lipodystrophy and body image concerns, similar to findings of other studies. Fifty‐six percent reported weight improvements following dietetic consultation. Body image is a frequent referral trigger, therefore improvements should be made to identify and treat patients with body shape issues. Conclusions: Dietitians are effective at achieving weight gain in HIV positive patients with a BMI <20 kg m−2 using nutritional counselling methods with or without oral nutritional supplementation; these patients experienced a 3.3% weight gain. Strategies need to be implemented to reduce the number of patients lost to follow‐up, as weight loss is a key morbidity and mortality indicator in HIV. References Grinspoon, S. & Mulligan, K. (2003) Weight loss and wasting in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 69–78. Nerad, J., Romeyn, M., Silverman, E., Allen‐Reid, J., Dieterich, D., Merchant, J., Pelletier, V., Tinnerello, D. & Fenton, M. (2003) General nutritional management in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 52–62. Ockenga, J., Grimble, R., Jonkers‐Schuitema, C., Macallan, D., Melchior, J.C., Sauerwein, H.P., Schwenk, A. & Suttmann, U. (2006) ESPEN guidelines on enteral nutrition: wasting in HIV and other chronic infectious diseases. Clin. Nutr.25, 319–329. Paton, N.I., Sangeetha, S., Earnest, A. & Bellamy, R. (2006) The impact of malnutrition on survival and the CD4 count response in HIV‐infected patients starting antiretroviral therapy. HIV Med.7, 232–330. Power, R., Tate, H.L., McGill, S.M. & Taylor, C. (2003) A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals. Sex. Transm. Infect.79, 137–141. Sattler, F. (2003) Body habitus changes related to lipodystrophy. Clin. Infect. Dis36 (Suppl. 2): 84–90.

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