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TINJAUAN PUSTAKA
Good Nutrition for Quality of Life of PLWHA
(People Living with HIV/AIDS)
Siti Rahayu Nadhiroh
Public Health School - Airlangga University
ABSTRACT
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Key words: HIV/AIDS, good nutrition, quality of life
INTRODUCTION Providing nutritional care and support for people living
AIDS has emerged as one of the most serious diseases with HIV/AIDS is an important part of caring at all stages
IDFLQJWKHGHYHORSLQJZRUOG6LQFHWKH¿UVWFDVHZDV of the disease. Optimal nutrition can help boost immune
reported in 1981, HIV/AIDS have infected more than 40 function, maximize the effectiveness of antiretroviral
million people around the world. In Indonesia, the recent therapy, reduce the risk of chronic illnesses such as
situation indicated HIV/AIDS cases mount sharply and diabetes and cardiovascular disease, and contribute to a
TXLFNO\VLQFH¿QGLQJRILQ 'DWDIURP'HSNHV5, better overall quality of life (Highleyman, 2006).
(till December 2006) showed, there were 8194 AIDS This matter being interesting for discussed. How HIV/
cumulatif cases and killed 1871people. The data did AIDS substantially affects one’s quality of life. What
not explain the number truthfully as that happened at the relationship between nutrition and HIV/AIDS, and
iceberg phenomenon. Estimated, 169 thousand till 216 how nutrition can contribute to a better quality of life of
thousand people in Indonesia have contagious of the virus. PLWHA.
Boulton (2004) said, although the big attention focused on
overcoming AIDS problem in Africa and western country HIV/AIDS AND THE IMPACT ON QUALITY OF
nowadays, but some expert warned about the danger of LIFE
AIDS in the three big country in Asia. Those are China, HIV/AIDS substantially affects one’s quality of life in
India and Indonesia. many ways such as physical, social, psychological, and
Considering the spread of HIV/AIDS which sexual condition. The most prevalent constrain often faced
progressively extend and can be groggy of nation life, ZHUHLQWKHSV\FKRVRFLDOGRPDLQLQFOXGLQJ¿QDQFLDO
especially young generation, we need the effort of HIV/ problems, worry about disease progression, worry about
AIDS preventing and overcoming effectively. Besides that, the family and distress about losing others from HIV.
improving quality of life of PLWHA (people living with AIDS kills the most productive and reproductively
HIV/AIDS) is eesssseennttiiaall ttoo mmaaiinnttaaiinn hheeaalltthh aanndd pprroolloonng g active members of society, thus increasing the number
lives of them. of dependent household members, reducing household
Nutritionally adequate food in both quantity and productivity and caring capacity, and interrupting the
quality are required because it will improve the life quality transfer of local knowledge and skills from one generation
and life expectancy of PLWHA. Almost of them live in WRWKHQH[W 3LRW 7KLVFRQGLWLRQKDVLQÀXHQFHG
developing countries where healthcare, resources and VLJQL¿FDQWO\WRWKH3/:+$¶VTXDOLW\RIOLIH
drugs are scarce. So a balanced diet is a positive way of Quality of life is a multi-dimensional concept whose
responding to the illness. GH¿QLWLRQDQGDVVHVVPHQWUHPDLQVFRQWURYHUVLDO4XDOLW\
29
of life is conceptualized in terms of “an absence of pain Medications: Antiretrovirals (ARVs), and other
or an ability to function in day to day life” (Susan et al., PHGLFDWLRQVFDQFRQWULEXWHWRQXWULHQWGH¿FLHQFLHVDQG
1999). Several researchers described Quality of life as imbalances, either due to direct drug-nutrient interactions
D³¿JKWLQJVSLULW´DVVRFLDWHGZLWKORQJHUVXUYLYDOWLPH or drug side effects. Antibiotics may interfere with
for individuals (Friedland et al., 1996). “Quality of life nutrition by killing off beneficial bacteria in the gut
relates both to adequacy of material circumstances and to (Highleyman, 2005). Although costly medications have
personal feelings about these circumstances. It includes extended longevity, frequent drug side effects not only
“overall subjective feelings of well being that are closely affect nutrient intake but can cause troublesome metabolic
related to morale, happiness and satisfaction (Lesserman abnormalities as well. Following effective nutritional care
et al., 1992) guidelines helps the symptomatic person living with HIV
The research conducted by Testa and Lenderking to improve their response to medications and to deal with
(1999), showed the impact of AIDS-associated wasting metabolic changes. So, proactive nutrition intervention can
on quality of life, base on aspects of functioning (physical, result in fewer complications, leading to a reduced cost of
psychological, social and sexual). On physical functioning, care and increased quality of life (Meyer, 2000).
nearly all participantsreported functional limitations, some ,QDGHTXDWHLQWDNH: There are several reasons for a
quite severe, due to lack of energy or muscle weakness. person to reduce their intake in food. The person may be
On psychological functioning, participants reported that suffering from an infection, such as mouth sores or fever.
wasting evoked feelings of hopelessness, loss of power, Side effects from medications used to treat an illness may
grief, depression, preoccupation with morbid thoughts, cause a reduction in appetite. Depression from dealing
anxiety, fear, panic and even anger. On Social Functioning, with a fatal disease and possible social stigma can also
the primary areas reported were loss of social interaction, cause people to lose their appetite and reduce their food
fear of rejection, being forced to hide the condition intake (Fanta, 2001).
from friends, inability to form new relationships, social Altered nutritional requirements: By altering
isolation because of fear of rejection and an inability to metabolism, people with HIV/AIDS may require more
deal with the empathyexpressed by friends and relatives. calories, macronutrients, and specific vitamins and
Participants also reported a reduced capacity to enjoy minerals. Chronic illness may also alter hormone and
social interactions such as playingwith grandchildren and cytokine levels, which may have nutritional implications
dating. The last - RQVH[XDOIXQFWLRQLQJ- most participants (Highleyman, 2005). Because of these effects, an HIV-
expressed an overall loss of libido, feelings of shame and infected person has additional nutrient requirements: 10-
guilt, reduction in sexual drive, embarrassmentconcerning 15 percent additional energy intake and 50 to 100 percent
appearance to the point of severe inhibition and ageneral increase in protein intake as compared to a non HIV-
decrease or complete elimination of sexual energy. infected person (Fanta, 2001). Conversely, nutritional
deficiencies can impair immune function, potentially
worsening HIV disease progression. Research has shown
HIV/AIDS AND NUTRITION that depletion of vitamins A, C, and E, the B-complex
Nutritional Problem on PLWHA vitamins, and the minerals selenium and zinc can interfere
with cell-mediated immunity (CD4 cell, natural killer cell,
As mentioned above, people living with HIV/AIDS and neutrophil proliferation and activation), antibody
face many problems due to HIV infection. One of them production, and normal cytokine signaling (Highleyman,
is about nutritional problem. Malnutrition is a major 2005).
and early problem in HIV infection. Several factors can Nutrition means different things at the various stages of
contribute to nutritional problems in people with HIV/ HIV infection. The following is about nutritional needs and
AIDS, that are; problems according to the development of the disease.
Malabsorption: HIV or associated infections can
damage the lining of the gastrointestinal tract, which Stage 1: HIV infected and still healthy
can interfere with absorption of nutrients. Some HIV San Francisco AIDS Foundation (2006) stated that
SRVLWLYHSHRSOHH[SHULHQFHVSHFL¿FSUREOHPVVXFKDVIDW up to 70% of people newly infected with HIV will
malabsorption, which can impair absorption of fat-soluble H[SHULHQFHVRPH³ÀXOLNH´V\PSWRPVGXULQJWKLVVWDJH
vitamins (Highleyman, 2005). These symptoms, which usually last no more than several
Opportunistic infections (OI): Community-based days, might include fevers, chills, night sweats, and
research studies in the USA revealed that moderate weight rashes. Afterward, the infected person returns to feeling
ORVV DQGVHYHUHZHLJKWORVV í RYHUDIRXU and looking completely well. The remaining percentage
month period were associated with a subsequent increased of people either do not experience symptoms of acute
risk of opportunistic infections, including Pneumocystis infection or have symptoms so mild that they may not
jiroveci (formerly P. carinii) pneumonia, cytomegalovirus, notice them.
and the Mycobacterium avium complex, and with mortality Kennedy (2001) said, the goal during this stage is to
(Wheeler, 1998). keep the body weight stable in order to strengthen the
The Indonesian Journal of Public Health, Vol. 3, No. 2, November 2006: 2934
30
ERG\¶VDELOLW\WR¿JKWLQIHFWLRQVZLWKWKHLPPXQHV\VWHP The Relationship Between HIV/AIDS and Nutrition
and to prevent progression of the HIV illness. During the Nutrition is an important health issue for everyone,
early stage of the infection the emphasis is on a normal but particularly for people living with HIV/AIDS. WHO
and healthy balanced eating pattern. Remember that no (2005) stated that adequate nutrition cannot cure HIV
single food contains all the nutrients and goodness that the infection but is essential to maintain a person’s immune
body needs. By concentrating on eating a wide variety of system, to sustain healthy levels of physical activity,
healthy foods, health can be maintained during this early and for optimal quality of life. Adequate nutrition is
stage. Many people with the virus can live for 10 years or DOVRQHFHVVDU\WRHQVXUHRSWLPDOEHQH¿WVIURPWKHXVHRI
more if they maintain good nutrition. Meyer (2000) said, to antiretroviral treatment, which is essential to prolong the
DOORZPD[LPXPEHQH¿WDQGFRVWHIIHFWLYHQHVVQXWULWLRQDO lives of HIV-infected people and prevent transmission of
intervention and education should start at the time of HIV from mother to child.
initial HIV-positive diagnosis and continue throughout the The relationship between HIV/AIDS and poor nutrition
disease process. is cyclical. Kennedy (2001) said, the immune system
Stage 2: some problems but generally well resists infections and disease by fighting off germs,
bacteria, viruses and parasites that people are exposed to
It may take years for HIV symptoms to develop. daily. With HIV infection the immune system is weakened
However, even though no symptoms are present, the RUGH¿FLHQW7KLVSURWHFWLYHV\VWHPRIWKHERG\LVPDGHXS
virus is multiplying (or making copies of itself) in the of certain proteins, called antibodies, and cells that attack
body during this time (anonymous, 2006). The health invading germs. The T-cells and B-cells (or lymphocytes)
problems may include mononucleosis-like syndromes, KHOSWR¿JKWLQIHFWLRQ7KHVHO\PSKRF\WHVDUHIRXQGLQ
unexplained lymphadenopathy, fever of unknown origin, the blood stream. The T-cells are an important defence
chronic fatigue, unexplained weight loss, chronic diarrhoea against germs and the B-cells make antibodies that assist
and unexplained dementia (Frame, 2003). LQWKH¿JKWDJDLQVWLQIHFWLRQ$KLJK7FHOOFRXQWLQGLFDWHV
Many health problem like loss of appetite, mouth a healthy immune system. If the T-cell count remains high,
sores and pain when swallowing will cause low food it contributes to a healthier and longer life. The lining of
intake and contribute to weight loss. Fanta (2001) said, the gut also contains cells of the immune system. Poor
well-chosen dietary practices can help manage illnesses nutrition can affect the lining of the gut negatively. This
associated with HIV/AIDS. An HIV-infected person means that germs and parasites can enter the body through
needs to consume foods that meet energy, protein and the gut.
micronutrient requirements. These foods should also help Vitamin A and vitamin C help to keep the lining of
to increase appetite, be easily digestible and promote and the gut and lungs healthy and strong to prevent germs
maintain weight gain. from entering the body. Because people living with HIV/
AIDS have a weakened immune system, they often suffer
Stage 3: more serious problems from infections that take advantage of this situation.
At this stage, more serious health problems will These infections are called opportunistic infections. Even
emerge. This matter because the immune system starts to minor infections, which a healthy immune system could
weaken. Certain infections or illnesses will develop, such easily overcome, can be severe or fatal in someone with
as severe diarrhea, severe weight loss, severe pneumonia, HIV/AIDS. Every infection places extra demands on
brain infections and the others, that are more common the immune system. Infections lead to loss of appetite,
when someone has a weakened immune system. eating problems and also diarrhoea. Repeated infections
Besides that, people with HIV will also experience lead to poor nutrition, which further disables the immune
RIVLJQL¿FDQWGHFUHPHQWVLQWKHTXDOLW\RIOLIHFRPSDUHG system. Poor nutrition undermines the immune system
to previous stage. The research conducted by Lubeck of all people, whether they are HIV positive or not. Poor
and Fries (2004) on 440 HIV-infected persons in San nutrition leads to lower T-cell counts.
Francisco showed, the individuals who progressed to Research shows that the chance of infection with the
AIDS had significant decrements in HRQoL (health- HIV virus might be reduced in individuals who have good
related quality of life) compared with symptomatic and nutritional status, with micronutrients and, especially,
asymptomatic patients. The assessment covered the aspects vitamin A playing significant roles (ACC/SCN, 1998a).
of disability, energy, general health, pain, mental health, At the same time, the onset of the disease and even
social functioning, health distress and symptoms. death might be delayed in well-nourished HIV-positive
Kennedy (2001) said, with good nutrition the individuals (ACC/SCN, 1998a).
development of this stage is slower and the person can Thereby, nutrition and HIV are strongly related to each
survive for longer. If a person with HIV/AIDS has a good other. Fanta (2001) explained that relation. Any immune
appetite and is eating well, but is still feeling ill and losing impairment as a result of HIV/AIDS leads to malnutrition,
weight rapidly during this stage, it might be a sign that and malnutrition leads to immune impairment, worsens the
there is another infection, such as tuberculosis. Advice effect of HIV and contributes to more rapid progression
should be sought from health workers if this is the case. to AIDS. Thus malnutrition can both contribute to and
*RRG1XWULWLRQIRU4XDOLW\RI/LIHRI3/:+$
31
Siti Rahayu Nadhiroh
result from the progression of HIV. A person who is 6WHS: Eat a varied diet, which includes the following
malnourished and then acquires HIV is more likely to food types: starchy foods; fruits and vegetables; dried
progress faster to AIDS, because his/her body is HIV beans, peas, soya, lentils and peanuts; meat and milk
DOUHDG\ZHDNDQGFDQQRW¿JKWLQIHFWLRQ$ZHOOQRXULVKHG products; sugars, fats and oils.
person has a stronger body for coping with HIV and Starchy foods such as bread, rice, potatoes, sweet
¿JKWLQJLOOQHVV7KHVLPLODURSLQLRQVXEPLWWHGRQWKH potatoes, cereals, corn, sorghum and so on. These high-
scheme below by Piwoz and Prebel (2000). energy foods help keep body weight stable and should
form the basis of meals. Woods (1999); James and
Relationship between good nutrition and HIV/AIDS 6KR¿HOG VDLGDQDFWLYHQRQ+,9LQIHFWHGDGXOW
requires approximately 2070 kcal/day. An HIV-infected
adult requires 10 to 15 percent more energy per day (or
approximately 400 additional kcal for men and 300 kcal
for women). A non HIV-infected man requires about
57grams/day of protein and a woman requires 48 grams/
day. An HIV-infected adult needs approximately 50 to 100
percent more protein for a total of 85 grams/day for men
and 72 grams/day for women.
Fruits and vegetables contain vitamins and other
Source: Adapted from Piwoz and Prebel, 2000. substances vital to health. Vitamins strengthen the immune
system and keep the linings of the lungs and the gut intact,
Good nutrition help to maintain ideal body weight of which reduces the risk of infectious organisms entering the
PLWHA. This will give stronger immunity and resistance body. Eat at least some of fruits and vegetables fresh every
to infection. The next, good nutrition will reduce the day; overcooking and soaking fruit and vegetables for long
sickness and make slower HIV/AIDS disease progression. periods can destroy their vitamin content.
If PLWHA get a wellness condition, they will eat well and Meat and milk products supply muscle-building
have a good appetite. So, PLWHA can reach a better life proteins and strengthen the immune system. Good protein
and get a good quality of life. VRXUFHV PHDWSRXOWU\¿VKHJJVGDLU\SURGXFWV PLON
milk powder, yoghurt, buttermilk, cheese). Edible insects
The Importants of Nutrition for People Living with like Mopani worms are also high in protein. Dried beans,
HIV/AIDS peas, lentils, peanuts, soya are good sources of protein too,
Good nutrition can contribute to the wellness and sense and are especially important for vegetarians.
of wellbeing of the PLWHA at all stages of the disease Sugars, fats and oils provide energy, and should be
and may even prolong life. Good nutrition means eating eaten in larger amounts after infections or periods of
foods that supply the body with all the nutrients that are weight loss. Apart from adding sugar to food, it can be
QHHGHGGDLO\:HFDQ¿QGDOOWKHQXWULHQWVIURPVWDUFK\ obtained from foods made with sugar (cakes, pastries,
foods, fats and oils, proteins, vitamins, minerals and water. biscuits and desserts). Fats and oils include butter,
The right balance of these nutrients promotes health and margarine, lard, cooking oil, cream, mayonnaise and salad
well-being. dressings (Anonymous, 2007).
An effective programme of nutritional care and support 6WHS ([HUFLVHWREXLOGPXVFOH
will improve the quality of life of people living with Regular exercise makes people with HIV/AIDS feel
HIV/AIDS (Fenton and Meyer, 1998; Fanta, 2001; FAO, better. Its help to relieve stress and stimulates the appetite.
2002), by: maintaining body weight and strength; prevents Simple activities, such as taking regular walks, help keep
malnutrition and wasting; replacing lost vitamins and muscles strong. The body uses muscles to store energy
minerals; improving the function of the immune system and protein that the immune system can draw upon when
DQGWKHERG\¶VDELOLW\WR¿JKWLQIHFWLRQ H[WHQGLQJWKH required.
period from infection to the development of the AIDS 6WHS 'ULQNDWOHDVWHLJKWFXSVRIÀXLG ZDWHUDQG
disease; improving response to treatment; reducing time RWKHUEHYHUDJHV DGD\
and money spent on health care; keeping HIV-infected This is particularly important if you’ve had diarrhoea,
people active, allowing them to take care of themselves, vomiting or night sweats, which cause water loss
their family and children; and keeping HIV-infected people (anonymous, 2007).
productive, able to work, grow food and contribute to the Step 5: Avoid alcohol (wine, beer, cider, alcoholic
income of their families. coolers, whiskey, rum, gin, vodka, cane). It can cause
Here is point plan to good nutrition: depression, interfere with medications and lead to reduced
6WHS: Pay attention on diet as soon as possible and food intake and hence weight loss (Fanta, 2001).
discuss the diet and related problems with a doctor or 6WHS *HWWKHHVVHQWLDOYLWDPLQVDQGPLQHUDOV
In a 1993 publication, from Tufts university, a general
nutritionist (Anonymous, 2007). recommendation was made, “supplements of vitamins
The Indonesian Journal of Public Health, Vol. 3, No. 2, November 2006: 2934
32
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