Ensuring Survival and Beyond
The struggle to manage and survive disease has always involved nutrition. It was long ago established that if you lose too much weight and crucial protein stores in your body, you simply cannot survive. Even more predictive of when death would occur is a compartment of the body referred to as body cell mass, which is made up of most of the body's calorie-using protein stores, including muscle and organ tissues. Nearly all of the body's processes occur in this compartment, and nutrients and medications are processed here. So it makes sense that these body compartments are essential to survival and proper functioning.

LOSING GROUND
There are several reasons for body-tissue loss. The first may be the infection process itself: Once HIV enters the body, the body responds to protect itself. This response causes fluids to shift (known as edema) and muscle-protein breakdown (catabolism) to produce chemicals, such as cytokines, that mediate the stress response. During the first phases of this response you might not see a weight change, as weight stabilizes because fluids pool up and muscles are broken down. This seems detrimental, but it is important–and normal–for the body's protective response. Attempts to prevent or reduce this stress response by intervening carries the risk of reducing the body's ability to protect itself.

The balance between the amount of fluid, calories, and protein in the diet and the amount that the body uses can be a tricky one. When the body revs up to deal with an infection, including HIV, it tends to use up more calories and protein. At the same time, your appetite can diminish and leave your body trying to do more, with less support. By continuing to eat, even when you don't feel like it, you may be able to blunt the detrimental effects of losing body stores while allowing the body to fully respond to the viral invader.

MAKING UP FOR LOST TIME
The simple way to look at the treatment process is to think of responses. If you aren't getting enough of the nutrients you need, then get them. If an infection or other disease process is causing the breakdown of body tissues, especially body cell mass, it is important to reduce HIV viral load and get rid of any opportunistic infection or other problem.

Although needs for fluids, calories, and protein vary between individuals, you can estimate some baseline nutrient requirements [See table below]. If you are having trouble eating enough, there are many calorie-containing supplements you can use to add nutrients. If eating and absorbing nutrients becomes a problem, talk with your physician and dietitian about strategies to treat problems with malabsorption and improve nutrient intake. These may include low-fat or low-residue diets; antidiarrheal or antinausea medications; appetite-stimulant medications; tube-feeding directly into the stomach or intestine; and parenteral nutrition (bypassing the gut and feeding directly into the bloodstream).

Antiretroviral medications have done much to reduce the assault by HIV on nutritional status, and as a result, many people with HIV have regained weight–in some, weight gain has exceeded desired body weight [See PlusClinic on page 41]. As long as your body is able to appropriately respond to treatment and adequate nutrient intake, things should go back to normal. If your body is not responding fully or normally, there will be other issues for you and your health care team to address. As with anything concerning HIV, the key to nutritional success is to keep on top of it.

Fields-Gardner is the director of services for The Cutting Edge, an HIV nutrition company in the Chicago area. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She has written a book on HIV medications and a clinicians' guide to nutritional management of HIV.