Integrating Nutrition Therapy into Medical Management of Human Immunodeficiency Virus
Johns Hopkins University School of Medicine, Baltimore, Maryland
This supplement to Clinical Infectious Diseases contains a report on the current nutrition management and concerns of HIV infection. It represents the collaborative work of >50 authorities who have brought a wide range of expertise to produce 9 documents in conjunction with 5 federal agencies: the Health Resources and Services Administration, the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Department of Veterans Affairs.
The subject is particularly timely. The science and strategies for management of HIV infection move with a velocity that is unparalleled by any other important disease in the history of medicine. Nutritional issues have moved at the same or an even quicker pace. In early years, the major nutritional concern was wasting, or “slim disease.” Since 1996, the extraordinary success of HAART has reduced the frequency of wasting, at least in the developed world, but has brought a whole new series of complex problems representing the complications of either the treatment or prolonged survival.
Issues addressed in this supplement concern general nutritional management, evaluation and intervention for wasting, insulin resistance, fat redistribution, dyslipidemia, lactic acidosis, food safety, and bone abnormalities. The majority of these issues represent complications of medical progress—concerns that were neither important nor predicted in 1995. Nevertheless, these are among the most challenging concerns confronting practitioners. Relevance is placed in perspective by the observation that modern management of HIV infection now requires substantial expertise in dealing with nutritional issues and access to this expertise, despite the fact that there have been virtually no guidelines that specifically target the nutritional care of the HIV‐infected population. This report on the nutrition management and concerns of HIV infection is consequently most welcome as timely, authoritative, and greatly needed.