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A nutritional screening audit of new adult out-patients with HIV

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National guidelines state nutrition screening should be done on all out-patients at first appointment as malnutrition is known to contribute to morbidity and mortality (NICE, 2006). Implementation of nutritional screening for adult out-patients newly diagnosed with HIV was audited at the Caldecot Centre, King's College Hospital. Methods: 

Sixty patients were included by selecting every third patient from list of 142 patients attending new patient clinic between 1 April 2006 and 28 February 2007. A doctor and dietitian collected all data from integrated care pathway (ICP) forms and descriptive statistical analyses were performed. Results: 

Information was available for 50 patients with a mean age of 35. Of these, height and weight were recorded in 49 (SD 8.0) but body mass index (BMI) calculated in only 28. The number of patients reporting symptoms to nurses were; weight loss = 34%, appetite loss = 38%, diarrhoea = 12%, vomiting = 10%. Amount and duration of weight loss were recorded for only eight patients (range 2–12.7 kg) and seven patients, respectively. Referral to dietitian was indicated for 23 patients but only 10 patients had evidence of a planned appointment. Patients were seen within the following time period: 1 week = 3; 2 weeks = 2; 3 weeks = 5. Median BMI was 24.5 kg m−2 (range 17.7–36.4). Seven patients had BMI of 20 or less, 15 were in over-weight range of which four were obese. One-third of patients had a low CD4 (<200 cells mm−3) indicating increased risk of opportunistic infection. Symptoms related to HIV and malnutrition (e.g. diarrhoea, candidiasis, TB, pneumonia) were recorded by physician for 22% of patients. Discussion: 

Essential data were not collected or calculated in the majority of cases perhaps because patients newly diagnosed with HIV often have other urgent social and medical problems. There is clearly a need for nutritional screening in this population as large numbers (33%) presented with advanced infection and HIV and malnutrition related symptoms were widely reported. Conclusion: 

Nutritional screening of new HIV positive patients is inadequate. Training and education, repeat screening, redesign of screening form, and/or improved care pathways may help improve the implementation of nutritional screening for adult out-patients with HIV. Reference 

National Institute for Health and Clinical Excellence (NICE). (2006) Nutritional Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline 32. London: National Institute for Health and Clinical Excellence.

Document Type: Research Article


Publication date: 2008-08-01

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