Other Nutritional Diseases

In many countries of the world, HIV infection and acquired immunodeficiency syndrome (AIDS) has become one of the leading causes of undernutrition and cachexia, especially in younger patients. Indeed, many of the syndromes and consequences of protein-energy malnutrition are also seen in AIDS cachexia, such as frequent respiratory and other infections, diarrhea, malabsorption, and rashes. Weight loss is an AIDS-defining symptom, and weight loss of a third of usual weight usually signifies terminal illness. Fortunately, new generations of protease inhibitors and other medications have dramatically slowed the progression of HIV infection in many patients, as well as reducing the vertical transmission rate. Indeed, some studies have suggested that multivitamin supplementation of pregnant mothers may itself reduce vertical transmission rates in developing countries where antivirals are difficult to obtain. Proper attention to nutrition, with early enteral energy and micronutrient supplementation, is an important part of care, which is best instituted long before weight loss becomes manifest.

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