Mr. W is a 25 year old male who was in a drug rehabilitation program last year. He has been admitted to the hospital with a history of weight loss, weakness and intractable diarrhea. His weight has dropped from 160 lbs. to 90 lbs. and he is also suffering from fever and night sweats. Physical examination reveals swollen lymph glands, tongue lesions of herpes simplex and ulcers in the perianal region. Further tests indicated depressed T-cell levels and the presence of Pneumocystis carinni. He was tested for HIV infection and the blood test for HIV infection antibodies was positive.

While in the hospital he developed several other symptoms: anorexia, fever, fatigue, nausea, vomiting, watery diarrhea and rectal incontinence. His temperature was 103°F (39.8°C) and was treated with antibiotics to which he did not respond. The amount of diarrhea increased markedly, necessitating intravenous hydration. He developed esophageal candiasis and a duodenal infection.

The patient did not tolerate a soft diet or nutritional supplements, continued to lose weight and had severe anorexia, abdominal cramping and bloating. Nutritional assessment was deficient in all aspects, showing a BMI <19, decreased muscle mass, and depleted total protein and serum albumin.

1) In which stage of HIV infection would you categorize Mr. W?

2) Name and describe the major clinical complications in the final stage of AIDS and explain how these complications profoundly compromise a patient's nutritional status.

3) What should be the goal of nutritional therapy based on assessment data and the patient's history?

4) By what route of feeding should nutrition support be administered? Explain your choice.

List several nutritional supplements that might be used to alleviate some of Mr. W's symptoms and increase his caloric intake when he is able to tolerate a diet again.