| Intervention |
Principles |
| Smoking cessation |
- Brief unambiguous statement about need to stop smoking
- If patient is not contemplating, try to motivate and emphasize positive short-term aspects (more money for better things, better taste for food, better skin, less dyspnoea), and long-term benefits (prevention of COPD, IHD, stroke, lung cancer)
- If patient is contemplating, try to fix stop date, establish reward system
- Use nicotine substitution (patch, chewing gum, spray), varenicline, or bupropion (note: both drugs may cause central nervous system side effects including suicide; bupropion may interact with PI and NNRTI) during weaning phase if necessary
- Consider referring patient to specialized stop smoking clinics
- Anticipate relapses, explain and consider them as part of the weaning process to final nicotine abstinence
|
| Dietary counselling |
- Dietary intervention should not interfere with the dietary requirements required for appropriate absorption of ART drugs
- Keep caloric intake balanced with energy expenditure
- Limit intake of saturated fat, cholesterol and refined carbohydrates
- Reduce total fat intake to < 30% and dietary cholesterol to <300mg/day
- Emphasize intake of vegetables, fruits, grain products with fibre
- Emphasize consumption of fish, poultry (without skin) and lean meat
- Consider referral to dietician, one week food and drink diary to discover ‘hidden’ calories
- Avoid binge eating (‘yo-yo dieting’)
- In patients with HIV-related wasting and dyslipidaemia address wasting first and consider referral to dietician
- Patients who are obviously overweight should be motivated to lose weight. Starvation diets are not recommended (immune defence mechanisms potentially decreased). Malnutrition has to be addressed where observed. Normal BMI range: 18.5-24.9; Overweight: 25.0-29.9, Obesity: > 30.0 kg/m2
- Intake of alcohol should be restricted to <20-40g/d
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| Exercise promotion |
- Promote active lifestyle to prevent and treat obesity, hypertension and diabetes
- Encourage self-directed moderate level physical activity (take the stairs, cycle or walk to work, cycling, swimming, hiking etc.)
- Emphasize regular moderate-intensity exercise rather than vigorous exercise
- Achieve cardiovascular fitness (e.g. 30 minutes brisk walking >5 days a week)
- Maintain muscular strength and joint flexibility
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