HIV & Nutrition:
HIV and nutrition are intimately linked. HIV infection can lead to malnutrition, while poor diet can in turn speed the infection’s progress. As HIV treatment becomes increasingly available in the poorest parts of the world, critical questions are emerging about how well the drugs work in people if they are short of food. Uncertainty also surrounds the role of vitamins and other supplements. And for those already receiving treatment, side effects such as body fat changes are a daily concern.Understandably, HIV positive people and those who care for them are interested in whatever might benefit their health. This article looks at what is known about the relationships between HIV and nutrition.
Dietary advice should be tailored to individual circumstances. However, in general he recommendations for people living with asymptomatic HIV infection are much the same as for everyone else, meaning a healthy, balanced diet.
Only three differences are worth noting:
Because people with untreated HIV tend to burn more energy, the total number of calories should be around 10% higher than the usual guideline amounts, and up to 30% higher during recovery from illness. The balance of fat, protein and carbohydrates should remain the same.
Many experts recommend a daily multivitamin (usually without iron, except in menstruating women or people with iron deficiency).
The World Health Organisation recommends vitamin A supplements every 4-6 months for young children living with HIV in resource-poor settings. HIV positive people suffering loss of appetite may need to make an extra effort to ensure they are eating enough. Helpful suggestions include eating several small meals per day, taking exercise to stimulate appetite, possibly mashing or liquidizing food to ease swallowing, and seeking advice from a health provider or dietician. If other approaches have failed to reverse wasting then doctors may recommend a liquid food supplement, an appetite stimulant, or resistance exercise to build muscle. Other possibilities include steroids and hormone treatments, though these can be expensive and have serious side effects.
Advice for people with lipodystrophy or lipid abnormalities can be found in our antiretroviral drug side effects page.
Because HIV and nutrition are so strongly linked, nutritional assistance is seen as an important part of the response to HIV. This may take the form of nutritional assessment, counseling, or food provision.
Nutritional assessment and counseling:
Nutritional assessment helps HIV positive people receive appropriate treatment, care and nutritional support. Even in the poorest settings, according to the World Health
“Screening for nutritional status and assessment of dietary intake should be included routinely in HIV treatment and care for adults and children.” A dietician can assess the patient’s diet, lifestyle and nutritional status, and provide counseling and referrals as necessary.
Nutritional counseling may include education on various topics, including:
Achieving or maintaining a healthy body weight
Managing lipid abnormalities and lip dystrophy
Managing dietary complications related to antiretroviral treatment
Managing symptoms that may affect food intake
Appropriate use of herbal and/or nutritional supplements
The role of exercise
Food safety (important for preventing opportunistic infections)