Good nutrition is very important for long-term health and survival. Studies have found that people living with HIV (HIV+) who have a healthy diet and good nutritional status can better tolerate HIV drugs, maintain weight and muscle mass more easily, and feel better overall.

Nutrients are things like fats, protein, carbohydrates, vitamins, minerals, and other important chemicals. You need proper levels of different nutrients in order to build and repair cells, keep hormones regulated, fight infection, and maintain energy levels. For the most part, we can not make nutrients. We get what we need from food and (when that is not possible) dietary supplements.

Good nutrition depends on many things, including:

• What you eat (how much, what type of food, etc.)
• How you digest and absorb nutrients
• How different parts of your body use these nutrients

HIV-related changes in any of these factors can affect your nutritional status. Over time, this can lead to a variety of nutritional problems, including:

• Weight loss
• Muscle wasting (loss of muscle)
• High levels of fats and sugars in the blood
• Not enough vitamins and minerals

Many of these HIV-related problems can be avoided, or partially managed, using nutritional strategies.

Nutritional status can be assessed in many ways, including:

• Weight and other measurements of body fat and muscle mass
• Hemoglobin or hematocrit counts, which measure iron in the blood
• Other blood tests to check levels of key fats, proteins (such as albumin), vitamins, and minerals

A healthy diet is a key part of any HIV treatment plan. A diet is simply any food and drink that you consume regularly. Your diet should give you the nutrients you need to:

• Fight weight and muscle loss
• Keep energy levels high
• Help you get what you need from medications you take
• Minimize the negative impact of HIV drugs

What kind of diet you should follow depends on your weight and your nutritional status (cholesterol, blood sugar, vitamin levels, etc). A nutritionist or registered dietician can help figure out what type of diet makes the most sense for you. AIDS service organizations and health-care clinics sometimes have nutritionists on staff.

Nutritional guidelines such as the Recommended Dietary Allowance (RDA) are set by the government to let people know how much of each nutrient they need each day to maintain good health. However, the RDA does not take into account that HIV infection increases these needs. One study showed that HIV+ people needed between 6 and 25 times the RDA of some nutrients.

Due to dieting (restrictive eating), eating unhealthy foods, lack of time, and other pressures, half of all women in the US do not eat what they need to meet even the basic RDA requirements for many nutrients. This puts women, especially HIV+ women, at particular risk for not getting enough nutrients to maintain their health.

With a chronic infection like HIV, your body burns more energy (calories). If you are using more than you are bringing in, you may lose weight. It is also possible to eat more calories than you are using, and thus gain weight. Either way, if you are not eating healthy foods, you can suffer from malnutrition and hurt your health.

Some HIV+ people need a higher daily calorie intake to prevent weight loss. Hunger is not always a reliable guide, because you can feel nauseous or turned off by food, even when you need it. If this is case, speak to your health care provider about ways to manage your nausea or stimulate your appetite.

Carbohydrates are a good source of energy, but can be a problem if you have diabetes. They are found in foods like:

• Bread
• Pasta
• Rice
• Cereal
• Potatoes

Carbohydrates come in different forms. Simple carbohydrates are more easily digested, but can cause your blood sugar to rise sharply. Simple carbohydrates include sugar (as in sweets, soft drinks), white rice, and white flour. They also occur naturally in fruits and milk.

Complex carbohydrates (also called starches) take longer for your body to digest, and often contain more fiber and other nutrients than simple carbohydrates. Complex carbohydrates include whole grains, beans (legumes), starchy vegetables like corn and potatoes, and brown rice. Because they take longer to digest, complex carbohydrates do not cause blood sugar to rise as sharply as simple carbohydrates and are therefore recommended for people with diabetes.

Protein (along with exercise) helps your body build and maintain muscles. During times of infection, protein stored in muscles can get burned as a fuel source. This can lead to loss of muscle, also called muscle wasting.

HIV+ people may need up to two times as much protein as HIV-negative people. It is important to try to eat at least three servings of protein every day. A good estimate of a ‘serving’ is the amount of food the size of your fist. Foods high in protein include:

• Lean meats, including beef, chicken, and pork
• Fish
• Cottage cheese and yogurt
• Eggs
• Beans, chickpeas, soybeans, and nuts

Animal sources of protein can be high in saturated fats, and should be used in moderation—especially if you have elevated cholesterol or you are at risk for heart disease.

A healthy gut is necessary in order for your body to get what it needs from foods, supplements, and medications. Foods high in fiber can help keep your bowel movements regular and support gut health. These include:

• Oats
• Whole grain bread
• Lentils
• Chickpeas
• Beans
• Fruits and vegetables
• Prunes and apricots

Water (8-10 8 oz cups a day), juices, fresh fruits, and vegetables can help you digest and eliminate waste. Drinking more water can help you avoid dehydration and constipation, and reduce the side effects of medications. Animal fat, especially dairy, can make diarrhea worse. If diarrhea is a problem, you may need to cut back on animal fat, fried foods, and sugary foods.

HIV+ people need more vitamins to build and repair tissue. It may not always be possible to get all the micronutrients (vitamins and minerals) from foods you eat. Not getting enough micronutrients can cause problems such as anemia.

While supplements do not replace a well-balanced diet, they can help you get the additional micronutrients you need. Most nutritionists treating HIV+ people recommend at a minimum:

• Regular use of a multivitamin (with trace elements)
• B Complex vitamins
• Additional supplementation as needed in individuals (such as calcium pills for women who do not get enough dairy)

Speak to your health care provider and see a registered dietician for a nutritional evaluation. They can help you determine what combination of diet changes and supplementation can correct any micronutrient shortages you have.

It's very important to protect yourself against infections that can be carried by food or water:

• Wash your hands before preparing or eating food
• Wash all fruits and vegetables carefully
• Do not eat raw or undercooked eggs or meat
• Use bottled water if the public water supply is not totally safe

It is not always easy to stick to a well-balanced and healthy diet. However, the benefits of good nutrition are clear. Well-nourished people have a healthier immune system and are better prepared to fight off infections. In addition, many HIV+ people use food and supplements to manage a variety of complications and side effects.

Think of your diet and supplements as part of your total strategy to fight HIV and stay healthy. Although research has yet to identify specific recommendations for HIV+ people, a well-balanced and varied diet that includes all vitamins and minerals seems to be the best way to go. Work with your health care provider and a dietician or nutritionist on a regular basis to develop the best plan for you.