Page 15 - Nursing Matters June 2021 Vol 12

current issues

emerged, it became clear that certain Diet and lifestyle interventions possible. This could include, but is not
drugs were more likely to result in weight limited to, the following:
gain than others. DTG, it appears, is As per a WHO global action plan for 1. Encourage patients to eat naturally
the main culprit, followed closely by obesity released in 2016, there exist two occurring foods and avoid those
RAL. From the data available, women, fundamental strategies to aid weight that are overly processed, which are
particularly those of African descent, loss: an increase in physical activity often high in sugar and fats.
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are at an increased risk of weight and a reduction in energy intake. 2. If packaged foods are bought, teach
gain, as well as those with lower CD4 Empowering patients to understand patients to read nutrition labels in
cell counts and higher viral loads at good nutrition in attempts to prevent order to choose the healthier option.
ART initiation. In addition, concomitant non-communicable diseases starts with 3. Encourage consumption of a variety
tenofovir alafenamide fumarate (TAF) understanding what’s on their plate. This of foods with a bigger portion
use (a kidney friendly alternative to TDF) includes identification of the basics of a (about half a plate) comprising of
appears to further amplify this weight balanced diet, an understanding of the fresh fruit and vegetables. 20
gained. 6,16 different food groups (macronutrients 4. South Africa is one of the largest
and micronutrients) and how to consumers of Coca-Cola (Coke)
balance energy intake and deficit by in Africa – a crucial aspect of
Obesity, denoted by a BMI of greater counting calories. As a result, patients counselling includes limiting the
2
than 30 kg/m , is not a health concern
isolated to South Africa. In 2016 the are encouraged to take control of their consumption of fizzy drinks which
21
own health and hopefully pass healthy
are high in sugar and calories.
World Health Organization (WHO) practices on to family and friends. 5. Preparation methods influence
estimated that 13% of adults (± the nutritional value of food and
650 million people) globally were Whilst clinic visits are often time restricted, are oftentimes easy measures to
obese, with a further 40% overweight healthcare workers are encouraged to adjust. For example, eating pap
according to BMI classifications. It dedicate time to health promotion where (mealie meal) once it has cooled
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is estimated than an increase of 5 kg/
m in BMI increases a person’s risk of
2
death by about 30%.17 Whilst limited
data exists in PLWH, the risk of death
is suspected to be the same as that for
the general population, and confers
multiple additional health complications
including hypertension, diabetes
mellitus, obstructive sleep apnea and
pregnancy-related complications.
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Several theories around why PLWH
gain weight on ART exist, with no
definitive answer nor a “one-size-fits-
all” solution available. One such theory
suggests a return to health phenomenon
where weight gain is the result of
slowed or eliminated viral replication
and alleviation of HIV-associated
inflammation, with improved appetite
and nutrient absorption. Another
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suggests that weight gain is inhibited by
older ARVs such as TDF and EFV through
unclear mechanisms. This was seen in the
ADVANCE clinical trial where patients
who were slow to metabolise EFV and
had higher circulating blood EFV levels,
tended to have slower weight gain as
compared to those who metabolised
EFV more quickly. 19

HIV Nursing Matters | June 2021 | page 13