World Aids Day, December 1st01 December 2014
To mark World Aids Day 2014, specialist HIV care dietitian, Alastair Duncan, gave us a current overview of how dietitians are working in this area.
HIV in the UK, 2014:
Almost 110,000 people in the UK are HIV positive, of which 26,000 are not yet aware of their diagnosis, and remain at risk of passing on the virus. 40% of the 5,000-6,000 people diagnosed with HIV each year have been positive for some considerable time and are profoundly immunosupressed at the point of diagnosis, and at a high risk of opportunistic infections and complications. This contrasts with those receiving high quality HIV care in the UK, where 90% of those prescribed antiretrovirals have achieved complete viral suppression. As a result of this, taken as a whole, people with HIV are ageing, with 25% now aged over 50.
Nutrition needs in HIV are diverse, and dietetic care remains an important facet of high quality care. For those newly diagnosed with HIV, a balanced nutritional intake has been shown to slow the rate of decline of the immune system as the virus attacks the body. Dietetic counselling is important when initiating antiretroviral therapy. Many patients gain too much weight after starting HIV medicines, and this can lead to complications including cardiovascular disease, high blood pressure, and Type 2 diabetes. Dietetic counselling has been shown to prevent this.
Additionally, some antiretrovirals must be taken with particular amounts of food for adequate absorption, and dietitians are best placed to advise on this. Those ageing with HIV may present with a variety of conditions associated with normal ageing, including cognitive decline, insulin resistance, loss of calcium from the bones, and higher cholesterol levels, however these appear to be happening at a significantly younger age than expected. Nutritional therapy has a key role here. Finally those who are profoundly immunocompromised can present with a need for urgent nutritional support.
Evolving Models of HIV Care
To achieve the highest quality of care for HIV patients in the UK, professional bodies representing all healthcare providers working in HIV have come together and founded FHIVA - the Federation of HIV Associations. FHIVA is launching guidelines for evolving models of HIV care, and DHIVA, the Dietitians in HIV group of the BDA, has been central to this work. Current Chair, Alastair Duncan, Lead Dietitian at Guy's and St. Thomas' NHS Foundation Trust in London, is co-Chaired of the Evolving Models of HIV Care event held to mark World Aids Day this year.
Ensuring the Highest Quality of Dietetic Care for those Living with HIV
All dietitians working with HIV patients are expected to attain a level of competency for working with this client group. These competencies have been developed by DHIVA, and are central to the UK Guidelines for HIV Care.