Human Immunodeficiency Virus: Nutritional Considerations

Nutritional issues in HIV infection relate to providing for calorie needs, avoiding nutrient deficiencies, and controlling cholesterol levels. A combination of medications and a healthful diet can improve immune function and decrease the risk for infections.

• Meeting Calorie Needs: Studies of HIV-infected men have shown increased resting energy expenditure and protein use, compared with non-HIV-infected individuals. HIV-infected individuals require increased calorie and protein intake to prevent wasting.
  
  Protein supplementation with amino acids (L-arginine and L-glutamine) and related compounds (such as beta-hydroxy beta-methylbutyrate, which is a metabolite of the amino acid leucine) may help prevent or reduce wasting in HIV-positive individuals, according to some studies. However, additional clinical trials are required before these supplements can be routinely recommended.
  
  Unless they are obese, patients should not be encouraged to lose significant amounts of weight. Studies have consistently shown that HIV-infected patients with a body mass index (BMI) higher than 25 are healthier than thinner HIV-infected patients. Loss of excess weight may be helpful, however, for overweight patients at a higher risk for heart disease.

• Ensuring Nutrient Adequacy: Preliminary evidence reveals that higher intakes of fruits, vegetables, and juices improve the immune system in HIV-positive patients. Fruits and vegetables also provide many nutrients that are deficient in persons with HIV and help reduce the side effects of antiviral therapy.
  
  Nutrient supplements may be helpful. Low blood levels of many nutrients occur in HIV-positive individuals and are associated with worsened disease. Although some reviews suggest that multivitamin supplements are helpful, others have found no such advantage. Preliminary evidence suggests that selenium supplementation (200 mg a day) may reduce the need for hospitalization by lowering the frequency of infections. Magnesium deficiency has also been found in roughly 60 percent of HIV-infected individuals. However, routine magnesium supplementation is not recommended except for persons on a medication called foscarnet, which frequently causes low magnesium levels.
• Controlling Cholesterol: Individuals with HIV often have elevated levels of cholesterol and triglycerides (particles of fat in the body), as a result of antiviral medications. Ten to 50 percent of patients on antiviral medications have high cholesterol and 40 to 80 percent of these individuals have high triglyceride levels. A diet that helps control cholesterol and triglycerides and addresses other cardiovascular risk factors is appropriate for people with HIV.