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Nutritional needs of people with HIV/Aids

Dietitian to Fedics, Annelize Zeelie, emphasises the need for a healthy, balanced diet to preserve the wellbeing of people with HIV/Aids.

As HIV attacks the body’s immune system, it has to work harder to fight infection, requiring an increase in energy and nutrients. People infected with HIV will therefore have to eat more to meet these extra energy and nutrient requirements, this will further increase as the symptoms of HIV/Aids develop and the virus progresses.

The three nutritional areas most affected by HIV/Aids are:

Food intake

People with HIV/Aids tend not to eat enough, not only due to the illness but also the medication to treat it may reduce the appetite, modify the taste of food and prevent the body from absorbing it. Symptoms such as a sore mouth, nausea and vomiting also make it difficult to eat; tiredness, isolation and depression also reduce the appetite and the willingness to make an effort to prepare food and eat regularly. For many there is simply not enough money to buy food.

Food absorption

Food, once eaten, is broken down by digestion into nutrients. These nutrients pass through the gut walls into the bloodstream and are transported to the organs and tissues in the body where they are needed. One of the consequences of HIV and other infections is that since the gut wall is damaged, food does not pass through properly and is consequently not absorbed.

Diarrhoea is another common occurrence in people with HIV/Aids. When a person has diarrhoea the food passes through the gut so quickly that it is not properly digested and fewer nutrients are absorbed. This reduced food intake and absorption leads to weight-loss and malnutrition.

Weight Maintenance

When a person does not eat enough food, or the food eaten is poorly absorbed, the body draws on its reserve-stores of energy from body fat, and protein from muscle. As a result the person loses weight as their body fat and muscles are lost. To gain or maintain weight, they will have to consume more food, either by eating larger portions and/or eating meals more frequently, using a variety of foods.

Coping with problems that might affect food intake:

Symptom Suggested therapy
Fever and loss of appetite
  • Drink lots of liquids like maas, mageu, yoghurt, fruit juice, vegetable and chicken soups.
  • Eat small portions of soft preferred foods and nutritious snacks throughout the day.
  • Make meals interesting and appealing – have a picnic
  • Avoid strong smelling foods.
Sore mouth and throat (problems with chewing and swallowing)
  • Eat soft moist foods (mashed potatoes, pasta dishes, soups, minced meat, soups, ice cream, custard, puddings). Use a sieve or fork or grater to soften foods.
  • Drink maas, mageu and yogurt with a straw.
  • Eat foods at room temperature.
  • Ice cold cool drink and ice cream often alleviate the pain.
  • Avoid:
    • Sticky foods that are hard to swallow (peanut butter)
    • Hard and dry foods e.g. potato chips, popcorn. Dip toast, crackers, biscuits and rusks in soup or milk to soften them.
    • Citrus fruits, pineapples, tomatoes and spicy foods
    • Spicy foods (chilli, curry)
Nausea and vomiting
  • Eat small meals more frequently throughout the day (six times a day).
  • Eat dry biscuits, toast and other plain dry foods.
  • Drink cold beverages such as clear fruit juices and soup and eat food cool or at room temperature.
  • Do not lie down immediately after eating
  • Avoid:
    • Strongly flavoured or spicy foods (curry)
    • Greasy foods (potato chips, pies)
Diarrhoea
  • Drink lots of fluids (soups, fruit juices, boiled water with salt and sugar).
  • Eat starchy foods (maize, rice, potatoes, white bread).
  • A grated apple (no skin), left to turn brown and mazeina pap can help stop the diarrhoea.
  • Eat frequent small meals.
  • Avoid:
    • Greasy foods
    • Caffeine (coffee, tea, coke, chocolates)
    • Drinking alcohol
    • Milk and milk products (yoghurt and sour milk can still be taken)
    • Food that cause gas (cabbage, cucumber, beans)
Fat malabsorption
  • Eat lean meat (trim all the fat from meat and remove the chicken skin).
  • Use tuna packed in water instead of oil.
  • Avoid:
    • Oils, butter, margarine and foods that contain or were prepared with them
    • Sausage, polony, bacon and fatty cold meats
Constipation
  • Drink lots of fluids (about eight cups a day).
  • Eat high fibre foods such as mebele, bran cereals, oats, brown or whole grain breads, samp and beans, raw fruits and vegetables (apples, oranges and carrots), dried fruits, nuts and seeds.
  • Avoid laxatives, enemas and liquid paraffin
Tiredness
  • Eat fresh fruits and vegetables that do not need preparing (banana, apple, carrot).
  • Drink high energy/protein drinks (maas, mageu, yoghurt).
  • Have someone preparing meals for you.
  • Avoid caffeine, alcohol, cigarette smoking and drug use.
Heartburn and bloatedness
  • Eat small frequent meals
  • Drink lots of fluids
  • Eat at least two hours before you sleep
  • Eat slowly and chew well
  • Avoid:
    • Greasy and fried foods
    • Gas forming foods (cabbage, broccoli, cucumber, sodas)
    • Spicy foods (curries, black pepper)
    • Alcohol, coffee, peppermint and chocolates
Muscle wasting
  • Eat a variety of meals daily from all three groups.
  • Eat high energy and protein rich foods (dairy foods, meat, fish, chicken, eggs).
  • Increase intake of starchy foods such as maize, rice, bread, potatoes, etc.
  • Use other fortified foods.
  • Add milk powder (Klim, Nespray, Clover, Elite), egg, margarine, oil, sugar, cream and peanut butter to your food.
Loss of taste/dry mouth
  • Use flavour enhancers/seasoning, spices, garlic, herbs and lemon.
  • Cheese, yoghurt, peanut butter, and ice cream make good alternatives.
  • Use foods that are moist or served with a sauce or gravy.
  • Drink liquids with meals and extra fluid between meals.
  • Chew sugarless gum or suck on mints, add lemon juice to liquids.

When treating HIV/Aids, different drugs are absorbed differently and have different side-effects; the after-taste can also sometimes be unpleasant. Here are some recommendations to promote maximum absorption, and minimise the side-effects and after-taste.

Drug use and food:

Regimen: Drug: Recommended to be taken:
1a Lamivudine, 3TC With food /  on empty stomach
Stavudine, d4T, Stavir , Zerit With food
Efavirenz, Stocrin Not with fatty meals, bedtime
1b Lamivudine, 3TC With food/on empty stomach
Stavudine, d4T, Stavir , Zerit With food
Nevirapine With food/on empty stomach
2 AZT, Zidovudine 30 mins before meals/1 hour after meals
ddI, Didanosine On empty stomach; drink fluids frequently, do not take antacids simultaneously
Ritonavir, Kaletra With high energy, high-fat meal (like a peanut butter and jam sandwich with soft margarine), suck ice to dull taste buds, chew strong flavoured chewing gum after dose. Avoid large doses of garlic.

Disguising the taste of these medications is important, especially with children. It is best done by adding a small amount of the drug to cold foods such as ice-cream, milk shakes, or fruit ices. The drugs can also be added to thick, sweet foods, such as honey, jellies, frozen juice, or small amounts of peanut butter, pudding, applesauce, or yoghurt. Make sure you use small quantities of food to disguise the drug; this will ensure that the entire dose of medication is consumed. – (Health24, August 2011)

– Information supplied by Inzalo Communications