MODULE 6

NUTRITIONAL SUPPORT FOR

ADHERENCE

GOAL
The goal of this module is to impart
knowledge and skills required in
Nutritional Support for Adherence.

OBJECTIVES
At the end of the session, participants will be
able to:
1. Describe nutrition in relation to HIV/AIDS
2. Describe food and Nutrition implications of
HIV
3. Describe the interactions between foods
and drugs and their effects on nutritional
status
4. Describe Nutrition related side effects of
ARV's.
5. Explain food and non-ART drug
interactions

OBJECTIVES contd
6. Recommend appropriate foods in relation
to possible side effects from common
medication use.
7. Explain the role of herbal remedies
8. Describe the role of dietary
supplementation
9. Apply the knowledge of Nutritional
Support in a drug-food plan for a PLHIV on
ARV's.

UNIT 1
NUTRITION

UNIT 2

FOOD AND NUTRITIONAL

IMPLICATIONS IN HIV

Implications
HIV and frequent infections increase the
bodys energy and nutrient requirements.
HIV destroys the bodys immunes response
and the bodys ability to resist diseases
which leaves the body vulnerable to frequent
opportunistic infections.
HIV and opportunistic infections may also
interfere with food intake and the way
nutrients are absorbed and used in the body.

Implications cont.
If the increased energy and nutrients needs
are not met a person infected with HIV may
lose weight or become malnourished.
If a person has a compromised nutritional
status his/her bodys immune response may
be weakened even further making him/her
more vulnerable to infections and hastening
the progression to AIDS.

THE CYCLE BETWEEN NUTRITION AND

HIV
Poor Nutrition
Resulting in weight loss, muscle
wasting, weakness, nutrient
deficiencies

Increased Nutritional
needs
Reduced food intake
and increased loss of
nutrients

Impaired immune
system

HIV

Increased vulnerability to
infections
e.g. Enteric infections, flu, TB
hence Increased HIV
replication, Hastened disease
progression Increased morbidity

Poor ability to fight HIV and

other infections, Increased
oxidative stress

UNIT 3
DRUGS AND FOOD
INTERACTIONS

UNIT 4
NUTRITION RELATED SIDE
EFFECTS OF ARV's

UNIT 5
FOOD AND NON-ART DRUG
INTERACTIONS

Effects of other Medications

Other medications used by PLHIVs can negatively affect
food and nutritional outcomes. e.g.
bitter and unpleasant after taste.
Diary products combined with tetracycline lessen
drug efficacy,
Aspirin can relieve pain but can cause gastric
ulceration.
Foods rich in certain chemicals may cause severe side
effects when taken together with certain drugs e.g.
tyramine, in cheese, taken together with isoniazid (antiTB drug) can cause a sharp rise in blood pressure.

UNIT 6
FOOD RECOMMENDATIONS
FOR POSSIBLE SIDE EFFECTS

Case study
Mr. L. is a 32-year old man whose partner and
child are also enrolled in MTCT-Plus. He has
180 CD4 cells and has been taking antiretroviral
medications for four months. He comes to a
routine clinical visit noting 2 weeks of diarrhea.
On clinical examination, he has lost 2 kgs and
appears mildly dehydrated. He does not have a
fever, abdominal pain, or blood in his stool

Question 1.
Why might Mr. L. has diarrhea?

Question 2
What are the possible interventions for the
case study?

UNIT 7
ROLE OF HERBAL REMEDIES

UNIT 8
ROLE OF DIETARY
SUPPLEMENTS

UNIT 9
DRUG-FOOD PLAN FOR PLHIV
ON ARVs

Introduction
Most first line ARVS in Kenya do not have
strict food restrictions though some
(Zidovudine, Efavirenz) should not be
taken with a high fat meal.
All drugs need to be taken as
recommended by the health worker.

Reasons for non adherence

Side effects or fear of side effects.
stigma
Forgetting to take drugs or misplacing of drugs.
Inability to make follow up visits to get drugs on
time.

Reasons for non adherence

Discouragement or depression especially
in the case of relapse of O.Is e.g.TB
Lack of food.
Lack of knowledge on how to schedule
daily intake of drugs

DRUG FOOD PLAN

What is a drug food plan?
A daily schedule specifying when meals and
drugs are to be taken in relationship with
each other.
Ensures drug-food interactions are
properly managed
Ensures drug regimens are adhered to
Ensures sufficient food is taken to meet
nutritional needs.

When does one need a drug food

plan?
One needs a drug food plan to:
Reduce the severity of the side
effects of some of the drugs.
Support nutritional needs of the client
Manage food restrictions
Improve drug adherence

COMPONENTS OF A DRUGFOOD PLAN

1. Medications currently being taken and
timing of the drugs
2. Food implications of the drugs
3. Dietary patterns and preferences of the
client
4. Food types/quantities accessible to the
family

Components contd.
5. Any symptoms that may affect food intake
or preferences-allergies & intolerances
6. The plan should be feasible, acceptable,
given the clients daily schedule
7. Information on what foods to avoid or
moderate e.g. alcohol, traditional herbs
etc

A drug-food plan should include:

Date column
Medication column
Special instruction column
Symptoms column
Morning, mid-morning, lunch, midafternoon, evening/night
Discuss with the client the need to change
eating patterns to promote effectiveness of
ARVs

THANK YOU