Good nutrition is critical for long-term health and survival. Studies have found that HIV+ people with 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’t make nutrients. We get what we need from food and (when that’s not possible) dietary supplements.

Good nutrition depends on many things, including:

• What you’re eating (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
• High levels of fats and sugars in the blood
• Vitamin and mineral deficiencies

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 body composition measurements (BIA, DEXA, or by hand with calipers)
• Hemoglobin/hematocrit counts
• 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. 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 which diet plan 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, eating unhealthy foods, lack of time, or other pressures, half of all women in the U.S. 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 nutrient deficiencies.

In a chronic infection like HIV, your body burns more energy (calories). If you’re using more than you’re bringing in, you may lose weight. Over time, too much weight loss can lead to malnutrition.

HIV+ people often need a higher daily calorie intake to prevent weight loss. Hunger isn’t always a reliable guide, because you can feel nauseous or turned off by food, even when you need it most. If this is case, speak to your doctor about interventions such as appetite stimulants or medications to control nausea.

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

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

HIV+ people may need 1.5 to 2 times as much protein as HIV- people. You should try to eat at least three serving of protein each day. Foods high in protein include:

• Beef
• Pork
• Chicken
• Fish
• Beans, chickpeas, soybeans, and nuts

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

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

• Oats
• Whole grain bread
• Lentils
• Chickpeas
• Beans
• Apples
• Raisins
• Prunes

Water (9–11 8 oz cups a day), juices, fresh fruits, and vegetables can help you digest and eliminate waste. Animal fat, especially dairy, can aggravate diarrhea. If diarrhea’s 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 isn’t always possible to get all the micronutrients (vitamins and minerals) from foods you eat. Vitamins deficiencies 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
• Additional supplementation as needed in individuals (such as calcium pills for women who don’t get enough dairy)

Speak to your doctor 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 deficiencies 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
• Don't eat raw or undercooked eggs or meat
• Use bottled water if the public water supply isn't totally pure

It’s not easy to stick to a well-balanced and healthy diet. But 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 doctor and a dietician or nutritionist on a regular basis to develop the best plan for you.

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