Nutritional management of patients with ARC or AIDS

Investigators are now predicting that 75 to 80 per cent of the 1.5 to 2.0 million HIV-positive patients in the United States will develop AIDS. The majority of AIDS patients will experience progressive weight loss and malnutrition prior to their death. Because nutritional therapy has clearly been demonstrated to have a beneficial effect on the clinical course and immunologic status of the critically ill general population, one must not disregard the potential positive benefits of nutritional therapy in the treatment of malnourished ARC/AIDS patients. As a result of the escalating cost of ARC/AIDS medical therapy and the predicted AIDS epidemic, ARC/AIDS nutritional therapy regimens must be simple to administer and cost effective. At SFGH, we have developed specific nutritional screening criteria in an attempt to identify those patients who would most benefit from nutritional therapy. Prior to initiating therapy, we interview each patient, perform a complete physical examination, conduct a thorough nutritional assessment, evaluate their gut function, and calculate their daily caloric and protein requirements. The selection of appropriate oral, enteral, and parenteral diets is crucial in the successful management of these patients. Because all ARC/AIDS patients differ in their nutritional requirements, diet tolerance, and degree of intestinal dysfunction, there is no single nutritional therapy regimen that can be utilized in the treatment of all these patients. Therefore, we recommend special individualized oral diets combined with food supplements and enteral and parenteral diets in the treatment of ARC/AIDS patients.