Nutritional management of patients with AIDS-related anorexia

Anorexia is a common problem in HIV infection and occurs via several mechanisms, including local pathology in the oral cavity or esophagus, central nervous system disease affecting eating mechanics or the perception of hunger, or secondary anorexia due to systemic infections, malabsorption, or medications, or to nonmedical factors, such as psychosocial problems, poverty, and isolation. The etiologic diagnosis of disorders of food intake is facilitated by using a diagnostic algorithm. The consideration of nutritional management centers around the body's nutritional reserves in addition to caloric intake. The specific management of a patient with poor food intake is based on the precise cause of the problem, and may include food-based and oral supplement therapies, appetite stimulants, or nonvolitional feeding via the enteral or parenteral route. Anabolic agents, cytokine inhibitors, and other therapies, such as resistance exercise, are adjunctive therapies, and do not replace adequate caloric intake.