Nutrition and HIV/AIDS

If you're HIV-positive, nutrition and HIV is a subject you'll want to pay special attention to. That's because
your body will undergo changes, both from medications and the disease itself. For example, you may
experience extreme weight loss, infections, or diarrhea. Another common change is lipodystrophy (fat
distribution syndrome) which can cause body shape changes and increases in cholesterol levels.
Making improvements in your diet can improve your health and how well you feel. Here are a few tips
that may help. A registered dietitian (RD) can give you even more guidance.

Why Nutrition and HIV/AIDS Are Linked

If you are HIV-positive, good nutrition can have several benefits. It can:

 Improve your overall quality of life by providing nutrients your body needs.
 Keep your immune system stronger so you can better fight disease.
 Help manage HIV symptoms and complications.
 Process medications and help manage their side effects.

The Basic Principles of Nutrition and HIV

The basic principles of healthy eating will also serve you well if you are HIV-positive. These principles
include:

 Eating a diet high in vegetables, fruits, whole grains, and legumes

 Choosing lean, low-fat sources of protein
 Limiting sweets, soft drinks, and foods with added sugar
 Including proteins, carbohydrates, and a little good fat in all meals and snacks

Here is more specific information to get you started with a healthier eating plan.
Calories are the energy in foods that provide your body with fuel. To maintain your lean body mass, you
may need to increase calories. To get enough calories:

 Consume 17 calories per pound of your body weight if you've been maintaining your weight.
 Consume 20 calories per pound if you have an opportunistic infection.
 Consume 25 calories per pound if you are losing weight.

Protein helps build muscles, organs, and a strong immune system. To get enough of the right types of
protein:

 Aim for 100-150 grams a day, if you are an HIV-positive man.

 Aim for 80-100 grams a day, if you are an HIV-positive woman.
 If you have kidney disease, don't get more than 15%-20% of your calories from protein; too much
can put stress on your kidneys.
 Choose extra-lean pork or beef, skinless chicken breast, fish, and low-fat dairy products.
 To get extra protein, spread nut butter on fruit, vegetables, or toast; add cheese to sauces, soups,
potatoes, or steamed vegetables; add canned tuna to salads or casseroles.

Carbohydrates give you energy. To get enough of the right types of carbohydrates:

 Eat five to six servings (about 3 cups) of fruits and vegetables each day.
 Choose produce with a variety of colors to get the widest range of nutrients.
  Choose legumes and whole grains, such as brown rice and quinoa. If you do not have
a gluten sensitivity whole-wheat flour, oats, and barley may be ok. If you do, stick with brown rice,
quinoa, and potato as your starch sources. If you are diabetic or pre-diabetic or have insulin
resistance, then most of your carbohydrates should come from vegetables.
 Limit simple sugars, such as candy, cake, cookies, or ice cream.

Fat provides extra energy. To get enough of the right kinds of fat:

 Get 30% of your daily calories from fat.

 Get 10% or more of your daily calories from monounsaturated fats.
Examples: nuts, seeds, avocado, fish, and canola and olive oils
 Get less than 10% of your daily calories from polyunsaturated fats.
Examples: fish, walnuts, flaxseed, and corn, sunflower, soybean, and safflower oil
 Get less than 7% of your daily calories from saturated fats.
Examples: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils.

Vitamins and minerals regulate your body's processes. People who are HIV-positive need extra
vitamins and minerals to help repair and heal damaged cells. Eat foods high in these vitamins and
minerals, which can help boost your immune system:

 Vitamin A and beta-carotene: dark green, yellow, orange, or red vegetables and fruit; liver; whole
eggs; milk
 B vitamins: meat, fish, chicken, grains, nuts, white beans, avocados, broccoli, and green leafy
vegetables
 Vitamin C: citrus fruits
 Vitamin E: green leafy vegetables, peanuts, and vegetable oils
 Selenium: whole grains, nuts, poultry, fish, eggs, and peanut butter
 Zinc: meat, poultry, fish, beans, peanuts, and milk and other dairy products

Because it is difficult to get enough of all the nutrients you need from foods, your health care provider
may recommend a multivitamin/mineral tablet (without extra iron). Check the label to make sure it
provides 100% of the recommended daily allowance (RDA). Discuss with your doctor what you're taking
-- more is not always better. If you don't eat at least three servings of high-calcium (green leafy veggies
or dairy) foods each day, you might need to add a calcium supplement to your diet. This is becoming
controversial however and more research is being done on this topic.

Nutrition and HIV: Coping with Special Problems

Your body may have a variety of responses to HIV and you may also experience side effects from
medications. Here are tips for dealing with some of the most common problems.
Nausea and vomiting

 Try bland, low-fat foods, such as plain pasta, canned fruit, or plain broth
 Eat smaller meals every one to two hours.
 Avoid greasy or spicy foods, or foods with strong odors.
 Drink ginger tea or ginger ale.
 Eat more cold foods and fewer hot foods.
 Rest between meals, but don't lie flat.
 Ask your doctor about nausea medications.
Diarrhea

 Drink more fluids than usual. Try diluted juices or Gatorade.

 Limit milk and sugary or caffeinated drinks.
 Eat slowly and more frequently.
 Avoid greasy foods.
 Try the B.R.A.T. diet (bananas, rice, applesauce, and toast) for a brief time.
 Instead of fresh produce, try well-cooked vegetables or canned ones.
 Try calcium carbonate supplements or fiber supplements like Metamucil wafers.

Lack of appetite

 Exercise to help stimulate your appetite.

 Don't drink too much right before meals.
 Eat with family or friends, making meals as attractive as possible.
 Try smaller, more frequent meals.
 Include a variety of textures, shapes, and colors.
 Ask your doctor about medications that stimulate appetite.

Too much weight loss

 Include more protein, carbohydrates, and fats in your diet.

 Use cream or half and half on cereals. Add ice cream to desserts.
 Eat dried fruits or nuts for snacks.
 Talk to your doctor about adding a nutrition supplement, such as Boost, Ensure, or Carnation
Instant Breakfast.
 Ask your doctor about medications that stimulate appetite and treat nausea.

Mouth and swallowing problems

 Eat soft foods such as yogurt or mashed potatoes.

 Avoid raw vegetables; cook them instead.
 Choose softer fruits, such as bananas or pears.
 Stay away from acidic foods, such as oranges, lemons, and tomatoes.
 See your doctor to make sure you do not have an opportunistic infection or need more diagnostic
testing.

Lipodystrophy (fat redistribution syndrome)

 Limit fat, especially saturated and trans fats.

 Choose unsaturated fats and sources of omega-3 fatty acids, such as salmon and tuna.
 Limit alcohol, and refined sugars.
 Prevent insulin resistance by limiting foods that raise glucose and insulin levels: primarily
carbohydrates.
 Eat more fiber-rich whole grains, fruits, and vegetables.
 Exercise.
Why is nutrition important?

Nutrition is important for everyone because food gives our bodies the nutrients they need to stay healthy,
grow, and work properly. Foods are made up of 6 classes of nutrients, each with its own special role in the
body:
Protein builds muscles and a strong immune system.

Carbohydrates (including vegetables, fruits, grains) give you energy.

Fat gives you extra energy.

Vitamins regulate body processes.

Minerals regulate body processes and also make up body tissues.

Water gives cells shape and acts as a medium where body processes can occur.

Having good nutrition means eating the right types of foods in the right amounts so you get these important
nutrients.

Do I need a special diet?

There are no special diets, or particular foods, that will directly boost your immune system. But there are
things you can do to keep your immunity up.
When you are infected with HIV, your immune system has to work very hard to fight off infections--and this
takes energy (measured in calories). For some people, this may mean you need to eat more food than you
used to.
If you are underweight--or you have advanced HIV disease, high viral loads, or opportunistic infections--you
should include more protein as well as extra calories (in the form of carbohydrates and fats). You'll find tips for
doing this in the next section.
If you are overweight, you should follow a well-balanced meal plan such as the ones presented on the U.S.
government's Choose My Plate website (www.choosemyplate.gov/). Keep in mind, you may need to eat more
nutritious foods to meet your body's needs.

How do I keep from losing weight?

Weight loss can be a common problem for people with relatively advanced stages of HIV infection, and it
should be taken very seriously. It usually improves with effective antiretroviral therapy (ART). Losing weight
can be dangerous because it makes it harder for your body to fight infections and to get well after you're sick.
People with advanced HIV often do not eat enough because:
HIV may reduce your appetite, make food taste bad, and prevent the body from absorbing food in the right
way; some HIV medicines may also cause these symptoms (if this is so, tell your HIV specialist--you may be
able to change to medications that do not have these side effects)

Symptoms like a sore mouth, nausea, and vomiting make it difficult to eat

Fatigue from HIV or the medicines may make it hard to prepare food and eat regularly

To keep your weight up, you will need to take in more protein and calories. What follows are ways to do that.

To add protein to your diet

Protein-rich foods include meats, fish, beans, dairy products, and nuts. To boost the protein in your meals:
Spread nut butter on toast, crackers, fruit, or vegetables.

Add cottage cheese to fruit and tomatoes.

Add canned tuna to casseroles and salads.

Add shredded cheese to sauces, soups, omelets, baked potatoes, and steamed vegetables.
 Eat yogurt on your cereal or fruit.

Eat hard-boiled (hard-cooked) eggs. Use them in egg-salad sandwiches or slice and dice them for tossed
salads.

Eat beans and legumes (pinto and other beans, lentils, etc), nuts, and seeds.

Add diced or chopped meats to soups, salads, and sauces.

Add dried milk powder or egg white powder to foods (such as scrambled eggs, casseroles, and milkshakes).

To add calories to your diet

The best way to increase calories is to add extra fat and carbohydrates to your meals.
Fats are more concentrated sources of calories. Add moderate amounts of the following to your meals:
Butter, margarine, peanut butter, gravy

Sour cream, cream cheese, grated cheese

Avocados, olives, salad dressing

Carbohydrates include both starches and simple sugars.

Starches are in:
Breads, muffins, biscuits, crackers

Oatmeal and cold cereals

Pasta, potatoes, rice

Simple sugars are in:
Fresh or dried fruit (eg, raisins, dates, apricots, etc)

Jelly, honey, and maple syrup added to cereal, pancakes, and waffles

How can I maintain my appetite?

When you become ill, you often lose your appetite. This can lead to weight loss, which can make it harder for
your body to fight infection.
Here are some tips for increasing your appetite:
Try a little exercise, such as walking or doing yoga. This can often stimulate your appetite and make you feel
like eating more.

Eat smaller meals more often. For instance, try to snack between meals.

Eat whenever your appetite is good.

Do not drink too much right before or during meals. This can make you feel full.

Avoid carbonated (fizzy) drinks and foods such as cabbage, broccoli, and beans. These foods and drinks can
create gas in your stomach and make you feel full and bloated.

Eat with your family or friends.

Choose your favorite foods, and make meals as attractive to you as possible. Try to eat in a pleasant
location.

How much water do I need?

Drinking enough liquids is very important when you have HIV. Fluids transport the nutrients you need through
your body.
Extra water can:
Reduce the side effects of medications

Help flush out the medicines that have already been used by your body

Help you avoid dehydration (fluid loss), dry mouth, and constipation

Make you feel less tired

Many of us don't drink enough water every day. You should be getting at least 8-10 glasses of water (or other
fluids, such as juices or soups) a day.
Here are some tips on getting the extra fluids you need:
Drink more water than usual. Try other fluids, too, like noncaffeinated teas, flavored waters, or fruit juice
mixed with water.

Avoid alcohol.

Begin and end each day by drinking a glass of water.

Suck on ice cubes and popsicles.

Note: If you have diarrhea or are vomiting, you will lose a lot of fluids and will need to drink more than usual.
For more information, see the medication side effects and symptoms section.

Do I need supplements?
Our bodies need vitamins and minerals, in small amounts, to keep our cells working properly. They are
essential to our staying healthy. People with HIV need extra vitamins and minerals to help repair and heal cells
that have been damaged.
Even though vitamins and minerals are present in many foods, your health care provider may recommend a
vitamin and mineral supplement (a pill or other form of concentrated vitamins and minerals). While vitamin
and mineral supplements can be useful, they can't replace eating a healthy diet.
If you are taking a supplement, here are some things to remember:
Always take vitamin pills on a full stomach. Take them regularly.

Some vitamins and minerals, if taken in high doses, can be harmful. Talk with your health care provider
before taking high doses of any supplement.

Below is a table of some vitamins and minerals that affect the immune system.

Vitamins and minerals that affect the immune system

Name What It Does Where to Get It About Supplements

Liver, whole eggs; milk; dark

green, yellow, orange, and red It's best to get vitamin A from food.
vegetables and fruit (such as Vitamin A supplements are toxic in high
Vitamin A Keeps skin,
spinach, pumpkin, green doses. Supplements of beta-carotene
and beta- lungs, and
peppers, squash, carrots, (the form of vitamin A in fruits and
carotene stomach healthy.
papaya, and mangoes); also vegetables) have been shown to
found in orange and yellow increase cancer risk in smokers.
sweet potatoes

Vitamin B Keeps the White beans, potatoes, meat,

group (B1, immune and fish, chicken, watermelon,
B2, B6, B12, nervous systems grains, nuts, avocados, broccoli,
folate) healthy. and green leafy vegetables

Helps protect the

Citrus fruits (such as oranges,
body from
Vitamin C grapefruit, and lemons),
infection and
tomatoes, and potatoes
aids in recovery.
 Important for
developing and
Vitamin D maintaining Fortified milk, fatty fish, sunlight
heathy bones
and teeth.

Protects cells Green leafy vegetables,

Vitamin E and helps fight vegetable oils, avocados, Limit to 400 IU per day.
off infection. almonds

Limit to 45 mg per day unless otherwise

instructed by your doctor. Iron may be a
Green leafy vegetables, whole problem for people with HIV because it
Not having
grain breads and pastas, dried can increase the activity of some
Iron enough iron can
fruit, beans, red meat, chicken, bacteria. Iron supplements can be
cause anemia.
liver, fish, and eggs constipating. Supplements that do not
contain iron may be better tolerated.
Ask your doctor.

Important for Whole grains, meat, fish,

Selenium the immune poultry, eggs, peanut butter, Limit to 400 mcg per day.
system. and nuts

Important for Meat, fish, poultry, beans,

Zinc the immune peanuts, and milk and dairy Limit to 40 mg per day.
system. products

Source: Adapted from the Food and Agriculture Organization of the United Nations

What should I know about food safety?

Paying attention to food and water safety is important when you have HIV, because your immune system is
already weakened and working hard to fight off infections.
If food is not handled or prepared in a safe way, germs from the food can be passed on to you. These germs
can make you sick.
You need to handle and cook food properly to keep those germs from getting to you.
Here are some food safety guidelines:
Keep everything clean! Clean your counters and utensils often.
Wash your hands with soap and warm water before and after preparing and eating food.

Check expiration dates on food packaging. Do not eat foods that are past the expiration date.

Rinse all fresh fruits and vegetables with clean water.

Thaw frozen meats and other frozen foods in the refrigerator or in a microwave. Never thaw foods at room
temperature. Germs that grow at room temperature can make you very sick.

Clean all cutting boards and knives (especially those that touch chicken and meat) with soap and hot water
before using them again.

Make sure you cook all meat, fish, and poultry "well-done." You might want to buy a meat thermometer to
help you know for sure that the meat is fully cooked. Put the thermometer in the thickest part of the meat,
not touching a bone. Cook the meat until it reaches 165-212 degrees F. on the thermometer.

Do not eat raw, soft-boiled, or "over easy" eggs, or Caesar salads with raw egg in the dressing. This includes
eating uncooked cookie dough or cake batter that contains uncooked eggs.

Do not eat sushi, raw seafood, or raw meats, or unpasteurized milk or dairy products.

Keep your refrigerator cold, set no higher than 40 degrees F. Your freezer should be at 0 degrees.

Refrigerate leftovers at temperatures below 40 degrees F. Do not eat leftovers that have been sitting in the
refrigerator for more than 3 days.

Keep hot items heated to over 140 degrees F, and completely reheat leftovers before eating.

Throw away any foods (like fruit, vegetables, and cheese) that you think might be old. If food has a moldy or
rotten spot, throw it out. When in doubt, throw it out.
 Some germs and parasites are spread through tap water. If your public water supply isn't totally pure, drink
bottled water.

Can diet help ease side effects and symptoms?

Many symptoms of HIV, as well as the side effects caused by HIV medicines, can be alleviated by using (or
avoiding) certain types of foods and drinks.
Below are some tips for dealing with common problems facing people living with HIV.

Nausea

Try the BRAT diet (bananas, rice, applesauce, and toast).

Try some ginger--in tea, ginger ale, or ginger snaps (these need to be made with real ginger root).

Don't drink liquids at the same time you eat your meals.

Eat something small, such as crackers, before getting out of bed.

Keep something in your stomach; eat a small snack every 1-2 hours.

Avoid foods such as the following:

Fatty, greasy, or fried foods

Very sweet foods (candy, cookies, or cake)

Spicy foods
 Foods with strong odors

Mouth and swallowing problems

Avoid hard or crunchy foods such as raw vegetables.

Try eating cooked vegetables and soft fruits (such as bananas and pears).

Avoid very hot foods and beverages. Cold and room temperature foods will be more comfortable to your
mouth.

Do not eat spicy foods. They can sting your mouth.

Try soft foods such as mashed potatoes, yogurt, and oatmeal.

Also try scrambled eggs, cottage cheese, macaroni and cheese, and canned fruits.

Rinse your mouth with water. This can moisten your mouth, remove bits of food, and make food taste
better to you.

Stay away from oranges, grapefruit, and tomatoes. They have a lot of acid and can sting your mouth.

Diarrhea

Try the BRAT diet (bananas, rice, applesauce, and toast).

Keep your body's fluids up (hydrated) with water or other liquids (those that don't have caffeine).
 Limit sodas and other sugary drinks.

Avoid greasy and spicy foods. High-fat foods can make diarrhea worse in some situations.

Avoid milk and other dairy products.

Eat small meals and snacks every hour or two.

Points to remember

You may feel that many things are out of your control if you have HIV. But you can control what you eat and
drink, and how much. Good nutrition is an important part of your plan to stay well.
Eating right can make your body and your immune system stronger.

When you are HIV-positive, you may need to eat more. Be sure to eat a diet that is high in proteins and
calories.

Exercise can stimulate your appetite and make you feel like eating more.

Drink plenty of liquids to help your body deal with any medications you are taking. If you are vomiting or
have diarrhea, you will need to drink more than usual.

Practice food safety. Keep your kitchen clean, wash foods, and be careful about food preparation and
storage. If your tap water isn't pure, drink filtered or bottled water.

You can use certain foods and beverages to help you deal with symptoms and side effects.

Before taking vitamin and mineral supplements, check with your health care provider.
Remember, there is no one "right" way to eat. Eating well means getting the right amount of nutrients for
your particular needs. Your doctor can usually refer you to a dietitian or nutritionist who can help design a
good diet for you

HIV/AIDS Precautions - Health Care

CLOSE ALL
What should I know when employed as a health care worker?
Consider blood and body fluids from all patients as potentially infective. Refer to Routine Practices for
preventing transmission of bloodborne infectious diseases. Common routes of exposure include
punctures from an infected needle or sharp, entry via mucous membranes (e.g., nose, mouth, etc.),
and any open wound.
Report immediately suspect fluid exposure, or a needlestick or sharp injury to a designated
person or health care professional.
Please also see the OSH Answers document HIV/AIDS in the Workplace for more information.

What personal protection should I wear?

Wear gloves:

 When you have open or healing wounds, or skin infections.

 When in contact with blood or body fluids, secretions, excretions or non-intact skin.
 When in contact with surfaces or articles contaminated with blood or body fluids.
 When performing venipuncture or other vascular access procedures.
 When carrying out cleaning or decontamination procedures.

Replace torn or punctured gloves immediately.

Use new gloves for every patient.
Wear protective eye wear, masks or face shields (with safety glasses or goggles) during procedures
likely to generate droplets of blood or body fluids.
In general, protective eye wear, masks and clothing are not needed for routine care of AIDS virus-
infected persons.
Wear gowns when the splashing of blood or body fluids may occur.
Wash hands:

 Before and after direct patient contact.

 Immediately and thoroughly when contaminated by blood or body fluids.
 After removing gloves.
 After a glove tear or suspected glove leak.
 Before leaving a work area.

The use of gloves does not eliminate the need for hand washing. Hand washing is one of the most
important procedures for the prevention of transmission.
What precautions should I follow when working with linen?
 Handle soiled linen as little as possible.
 Bag soiled linen at location.
 Transport linen in impervious bag if outside of linen bag is soiled. Process according to
hospital policy.
 Do not sort or rinse soiled linen in patient care area.

What precautions should I follow when performing cardiopulmonary

resuscitation?
 Use mouthpieces or other ventilation devices for CPR. Avoid direct contact with patients.
 Clean and sterilize equipment before reusing