| Patients on HAART may develop abnormal serum | | | | significant problem for HIV-infected men and women. |
| lipids, including hyper-cholestero-laemia, | | | | The risk factors for developing osteopenia or |
| hypertriglyceridaemia and decreased HDL cholesterol, | | | | osteoporosis include genetic predisposition, being |
| which predisposes them to increased risk of | | | | underweight, having low lean body mass, not |
| cardiovascular disease and pancreatitis. | | | | achieving potential peak bone mass density, having an |
| Nutritional therapy for dyslipidaemia | | | | accelerated rate of bone loss, low calcium intake, |
| PLWHA with hyperlipidaemia should reduce their | | | | vitamin D deficiency, inadequate or excessive protein |
| intake of total fat, especially satu-rated and | | | | intake, heavy alcohol use, low physical activity, |
| trans-fatty acids, salt and dietary cholesterol. | | | | smoking, male or female hypogonadism, |
| Overweight individuals should lose weight and all | | | | malabsorption, or amenorrhea/menopause. The |
| PLWHA should maintain a regular aerobic exercise | | | | aetiology of bone loss in HIV infection is unclear but |
| regimen. Those with hypertriglyceridaemia should also | | | | studies have shown increased rates of bone |
| limit simple carbohydrates, avoid alcohol altogether, | | | | turnover, disturbance of calcium and vitamin D |
| and quit smoking because it dramatically increases the | | | | metabolism, suppression of osteoblast formation, and |
| risk of cardiovasculardisease. Supplementation with | | | | negative effects of high levels of cytokines. Many |
| omega-3 fatty acids may enhance dietary efforts to | | | | HIV-infected persons have multiple risk factors for |
| lower triglycerides. Although lipid parameters may not | | | | bone loss regardless of HIV infection. The |
| completely normalize, PLWHA may be spared the | | | | development of osteopenia or osteoporosis results in |
| addition of further medications to an already high pill | | | | increased bone fragility and susceptibility to fractures |
| burden. It is essential to consider dietary strategies | | | | which further debilitates already vulnerable patients. |
| within the context of HIV disease, maintaining | | | | Nutritional therapy for bone mineral density |
| adequate energy and protein intake to prevent | | | | Nutrition is one of the most modifiable factors in the |
| weight loss in susceptible individuals. | | | | development and maintenance of bone mass. People |
| Abnormal Glucose Tolerance | | | | with normal bone density require 1000-1500 mg of |
| Abnormal glucose tolerance has been associated with | | | | elemental calcium, 400-800 IU of vitamin D, 320-420 |
| HAART, especially protease inhibitors. Studies have | | | | mg magnesium and 1.0-1.5 g/kg protein. Those with |
| shown that fasting glucose may be normal but 1 hour | | | | low bone mineral density require 1500-2000 mg |
| and 2 hour glucose tolerance tests are elevated. The | | | | elemental calcium and 800-1200 IU vitamin D. Other |
| aetiology is not clearly defined although insulin | | | | nutrients such as vitamin K, vitamin C and zinc are |
| resistance appears to be the underlying mechanism. | | | | also essential for bone formation but the benefits of |
| PLWHA with a family history of diabetes may be at | | | | supplementation are unproven. Smoking, alcohol, |
| increased risk of developing abnormal glucose | | | | excess salt and caffeine have also been implicated in |
| tolerance. The first line of therapy for hyperglycemia | | | | loss of bone mineral density. Body weight and lean |
| is diet and exercise. | | | | body mass should be maintained in the ideal range. |
| Nutritional therapy for abnormal glucose tolerance | | | | The importance of weight-bearing exercise cannot be |
| PLWHA should be counselled to consume consistent, | | | | overstated. Not only does exercise stimulate bone |
| mixed meals (protein, carbohydrate and fat) at | | | | formation, but individuals who exercise are stronger, |
| regular intervals throughout the day, to limit simple | | | | and are less susceptible to falls.Diarrhoea and |
| carbohydrates and increase fibre intake. Aerobic | | | | malabsorption should be treated to enhance |
| exercise facilitates glycaemic control, especially after | | | | absorption of necessary nutrients. Osteoporosis |
| a meal. | | | | treatment is provided according to standard medical |
| Osteoporosis | | | | therapy guidelines. |
| Loss of bone mineral density has emerged as a | | | | |