SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 18 (December 13, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

University of Nevada School of Medicine Provides Early Nutrition Intervention

The University of Nevada School of Medicine's "Early Nutrition Intervention in HIV and AIDS" project provides comprehensive nutrition assessment and intervention services to HIV-infected individuals. Noting that weight loss and nutritional deficiency in HIV-infected patients is associated with increased morbidity and mortality, the project seeks to identify and implement methods of early intervention to delay or prevent wasting, through the use of simple diagnostic techniques to identify clients at nutritional risk. Although traditional HIV-related nutritional services are provided when HIV-infected individuals have experienced extreme weight loss or are suffering from associated disease conditions, the project advocates early nutritional intervention. The project targets HIV-infected individuals who are relatively healthy and have not experienced any significant HIV-related weight loss; thus, the project seeks to identify interventions that can assist in preventing the wasting commonly experienced in the progression of HIV. A number of studies which provide data on the integration of simple nutritional measurements into the daily functioning of an ambulatory care HIV-treatment clinic have been initiated. Some initial findings are highlighted below.

Simple Physiological Measurements as Markers of Wasting. Preliminary data analyses have identified a number of simple diagnostic techniques that can serve as early warning signs of wasting in HIV-infected patients. For this study, HIV-positive clients were divided into three groups based on their CD4 cell counts: >300, 101-300, and <100. A number of physiological measurements (e.g. height, weight, measures of strength, dietary intake) were obtained to determine whether the three groups of clients differed on these measurement domains.

Specifically, analyses revealed that:

• weight decreased with decreasing CD4 count;

• muscle strength (hand grip) successfully differentiates HIV-positive subjects grouped by CD4 cell counts;

• muscle mass measurements such as triceps skinfolds and arm circumference had trends downward with declining CD4 counts.

Simple Dietary Records Analysis Correlates with More Complicated and Time-Consuming Dietary Analysis. The project also has investigated the efficacy of analyzing dietary intake records to assess the nutritional quality of diets of HIV-infected clients. Preliminary analyses demonstrate that a simple, expedient method of analyzing nutritional information – utilizing the USDA Food Guide Pyramid – correlated significantly with a more time-intensive computerized method of analyzing caloric and nutrient intake. Further analysis is underway to explore the ability of this simple method to identify HIV-positive clients at risk for nutritional deficiencies who would benefit from nutritional counseling.

The following abstracts of presentations made by project staff on these and other topics at the 11th International Conference on AIDS in Vancouver, BC in July, 1996 may be viewed here.

Simple Nutrition Evaluation Measures Provide Clues for Early Intervention in Weight Loss. T Larson, B Scott, R Brunner, S Navarro.

A Simple Review of Dietary Intake Records Accurately Estimates Nutrition Quality of Diets of HIV-Infected Men. B Scott, R Schnaible, T Larson, S Navarro, R Brunner.

Body Size in HIV/AIDS: Actual, Perceived and Preferred. R Brunner, B Scott, T Larson.

A Comparison of Change in Medical Students' Attitudes Toward AIDS Patients and Non-AIDS Patients. T Veach, R Brunner, T Larson.

For more information, contact Trudy Larson, M.D. at the University of Nevada School of Medicine, Department of Pediatrics, 411 West 2nd Street, Reno, NV 89503.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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