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What to Know About Nutrition and HIV

The human immunodeficiency virus (HIV) is a chronic type of retrovirus that can cause acquired immunodeficiency syndrome (AIDS). AIDS is the last stage of the HIV virus (1).

HIV attacks the body’s immune system, destroying white blood cells that are needed to fight off infections (2).

HIV treatment has come a long way, and people with HIV can live long and healthy lives if medication, including antiretroviral therapy (ART) medications, are accessible and taken as prescribed.

In addition to ART, many people with HIV are interested in natural ways to support their health, including diet and supplementation.

This article reviews the role of diet and supplementation in HIV-positive populations and gives recommendations for how to support overall health while living with HIV.

Nutrients, including protein, vitamins, and minerals, are necessary for the proper functioning of the body, including the immune system.

That’s why it’s important for all people, regardless of HIV status, to consume a varied diet that provides an array of nutrients.

A well-rounded diet can help support the health of the immune system and can reduce the risk of malnutrition.

HIV-positive people have higher needs for certain nutrients and are more likely to experience nutrient deficiencies than the general population. Plus, some nutrients are especially important for those with HIV, as they play an essential role in immunity and may help reduce side effects of ART (3).

People with HIV are at a higher risk for malnutrition

People with HIV are at higher risk for becoming malnourished compared with the general population: energy needs are around 10% higher in those with asymptomatic HIV and 20–30% higher in those with symptomatic HIV (4).

A 2019 study that included 812 HIV-positive people found that 11.45% of the participants were at some risk for malnutrition. The risk of malnutrition was higher in older adults and females. Hispanic participants also had a higher risk compared with Black and white participants (4).

That may mean that people with HIV — even those who are asymptomatic — have higher overall needs for calories and nutrients, including protein.

Although it’s recognized that people with HIV have higher protein needs than people who don’t have HIV, there are currently no guidelines for protein intake for people living with HIV.

According to older research, some experts recommend .45–.63 grams of protein per pound (1–1.4 g/kg) of bodyweight for HIV-positive people maintaining weight and muscle mass and .68–.9 grams per pound (1.5–2 g/kg) for HIV-positive people gaining weight and muscle mass (5).

Other studies have shown that nutritional supplements containing high amounts of protein can help people with HIV gain muscle mass and bodyweight (6, 7).

Plus, older research suggests that protein supplements may help improve immune function by increasing levels of certain blood cells that help fight infections, including CD4 lymphocytes (6, 8).

HIV attacks and destroys CD4 cells, which is why we use CD4 counts to assess the health of HIV-positive folks.

People with HIV are at a higher risk of nutrient deficiencies

People with HIV are more likely to be deficient in certain nutrients compared with the general population.

That’s likely due to immune dysfunction, higher nutrient needs, nutrient malabsorption, and ART-related side effects (9, 10, 11, 12).

Studies over time show that people with HIV are more likely to be deficient in many vitamins and minerals, including vitamin D, B12, folate, selenium, vitamin E, B6, and more (9, 10, 11, 12).

For example, numerous studies have demonstrated that HIV-positive people are at a significant risk of being deficient in vitamin D, which can negatively impact immune function (13).

Plus, vitamin D deficiency in people with HIV has been associated with bone disease, depression, high blood pressure, and infections (10).

Fortunately, research suggests that supplementing with vitamin D can replenish vitamin D levels and help improve markers of immune function, including CD4 counts (14).

Supplementation with a multivitamin or single-nutrient supplements may be helpful for those with HIV, as they can help treat deficiencies and support people with HIV in maintaining optimal nutrient levels.

However, it’s best for those with HIV to come up with a personalized supplement regimen with a team of healthcare professionals, since HIV-positive people have different nutrient needs depending on factors like diet, sex, age, and severity of disease.

If you have HIV, healthcare professionals can order bloodwork to assess levels of certain nutrients, such as vitamin D and B12, and make appropriate supplement recommendations based on your results.

Proper nutrition may help decrease ART-related side effects and improve treatment efficacy

A nutrient-dense diet may help reduce the risk of HIV medication-related side effects and improve treatment efficacy in people with HIV.

Some ARTs interfere with the body’s ability to metabolize glucose (sugars) and fats as well as negatively affect bone health, which may lead to increased risk of heart disease, type 2 diabetes, and decreased bone mineral density (15, 16, 17).

That is why it’s important for people with HIV taking ARTs to follow a healthy, balanced diet and supplement with certain nutrients when appropriate.

A diet rich in protein, healthy fats, and fiber could help improve ART- and HIV-related side effects like insulin resistance and high blood fat levels (17, 18).

For example, a balanced, high fiber, low glycemic index diet may help reduce blood fat levels and support healthy insulin and blood sugar regulation (19).

What’s more, supplementation with nutrients like vitamin D can help reduce ART-related complications like decreased bone mineral density (16).

Summary

People living with HIV have higher energy needs and face higher risks of developing nutrient deficiencies compared with the general population. ART can also lead to side effects like decreased bone mineral density and high blood lipid levels.

Energy (caloric) needs are around 10% higher in those with asymptomatic HIV and 20–30% higher in those with symptomatic HIV (4).

These increased energy needs can make it harder for those with HIV to gain and maintain bodyweight and muscle mass.

Notably, one study found that the risk of malnutrition was significantly higher in specific groups of people with HIV, including older adults, females, and Hispanic people (4).

What’s more, for HIV-positive people experiencing food insecurity, the risk of malnutrition is even higher, according to older research studies (20, 21, 22).

Malnutrition is associated with poor physical and mental health and poorer clinical outcomes in people with HIV (22).

Because HIV increases overall energy needs, it’s important for those living with this condition to follow a balanced diet, including regular meals and snacks, in order to prevent weight loss.

That’s essential for all HIV-positive people, regardless of whether they’re experiencing symptoms.

Although there’s no set protein intake guidelines for people with HIV, a higher protein diet appears to help promote muscle mass gain and maintenance (23).

Adding a source of protein to all meals and snacks can help ensure that you’re meeting daily protein needs. Examples of protein sources include chicken, fish, eggs, and beans.

Incorporating a protein powder supplement into the diet can also help people with HIV increase their daily protein needs.

Making a smoothie or protein shake with other nutrient-dense ingredients like nut butter, Greek yogurt, and berries can be a simple way to improve overall diet quality.

It’s important to note that people with HIV have varying nutrient needs, so there’s no one-size-fits-all diet when it comes to promoting overall health and supporting a healthy body weight.

Whenever possible, it’s helpful to get personalized advice from a medical professional like a registered dietitian.

Summary

People with HIV have higher nutrient needs, which increases the risk of weight loss and malnutrition. Eating regular, balanced meals and snacks can help support a healthy body weight and cover nutritional needs.

It’s clear that eating a nutritious diet high in vitamins, minerals, fiber, healthy fats, and protein is important for people living with HIV. Following a healthy diet can help support healthy body weight maintenance, immune health, mental health, and more.

However, there’s currently no specific dietary pattern recommended for all HIV-positive people.

Yet, because HIV compromises the immune system, food safety is important for those living with this condition (24).

Food safety

People living with HIV face greater risks of developing foodborne illnesses (food poisoning), so certain precautions should be taken in order to minimize those risks.

The United States Department of Health and Human Services recommends that HIV-positive folks avoid foods likely to cause foodbourne illness, including raw eggs, raw meat, unpasteurized dairy, and raw seafood. It’s also advised to wash fruits and vegetables thoroughly before eating (25).

Ways to help protect against foodborne illness include (25, 26):

  • using a separate cutting board when preparing meat
  • cooking foods like meat thoroughly
  • refrigerating perishable foods within two hours of cooking or purchasing
  • washing hands and utensils thoroughly after food preparation
  • paying special attention to the quality of water you drink

Nutrient-dense dietary patterns to consider

In addition to minimizing foodborne illness risks, it’s recommended that folks with HIV follow a diet high in nutritious foods that provide an array of nutrients, including vegetables, fruits, protein-rich foods like fish, and healthy fats like avocados, olive oil, nuts, and seeds.

Following a balanced diet can help minimize the risk of nutrient deficiencies and make sure your body gets sufficient amounts of protein, vitamins, minerals, and other important nutrients needed for immune function, muscle mass maintenance, and more.

It should be noted that some HIV-positive people experience diarrhea and other symptoms due to ART side effects, pathogens, and HIV-related intestinal damage.

Your healthcare team can prescribe medication to help reduce these symptoms and may recommend a special diet to help treat the diarrhea, whether it’s chronic or short-term.

Staying hydrated by drinking plenty of fluids is essential for everyone, including those with HIV. It becomes even more important if you’re also experiencing prolonged diarrhea, as it can lead to dehydration and other complications (27).

If you’re experiencing diarrhea or other gastrointestinal symptoms, it’s important to visit a healthcare professional so you can get appropriate treatment.

Lastly, people with HIV are at greater risk of developing certain health conditions. In fact, your risk of developing type 2 diabetes may be 4 times greater if you have HIV (17).

People with HIV are also more likely to develop heart disease (28).

Following a nutritious diet high in fiber, protein, and healthy fats may help reduce the risk of HIV-related health complications by improving blood sugar regulation, reducing blood lipid levels, and maintaining a healthy bodyweight.

What about supplements?

Every person with HIV has different needs and may benefit from different supplement regimens based on factors like dietary intake, nutrient deficiencies, and disease severity.

Some evidence suggests that some dietary supplements may be helpful for improving certain aspects of health in people living with HIV.

For example, one review of nine studies found that omega-3 supplements significantly reduced triglyceride levels and increased heart-protective high density lipoprotein (HDL) cholesterol in HIV-positive people (29).

A 2019 review that included 6 studies found some evidence that supplementation with 200 mcg of selenium per day over 9–24 months may help delay the decline of CD4 counts in people with HIV (30).

Vitamin D supplementation can help increase vitamin D levels in the body and has also been shown to reduce inflammation, protect bone health, and improve CD4 levels (31).

Supplementing with zinc, B12, folate, calcium, and other nutrients may also be helpful for those with HIV (32, 33, 34).

However, everyone living with HIV has different needs, so it’s important to develop a personalized supplement regimen with healthcare professionals. They can help you choose supplements that may be most helpful for you and can also recommend appropriate dosing.

It’s important for those with HIV to discuss all supplements with their healthcare team. Some dietary supplements, including herbs like St. John’s Wort and nutrients like vitamin C and some forms of calcium, can significantly reduce the effects of some ARTs (35).

Summary

Even though there’s currently no specific diet recommended for HIV-positive folks, a nutrient-dense diet high in healthy foods can help support overall health. Food safety is essential for reducing the risk of foodborne illness. Some supplements may be helpful, while others can interfere with ARTs.

In addition to following a nutritious diet, supplementing with certain nutrients, and taking steps to minimize the risk of foodborne illness, there are several other ways for people with HIV to promote optimal health.

  • Get regular exercise: Regular exercise can help reduce the risk of HIV- and ART-related complications like high blood lipid levels and muscle mass loss. It can also help improve overall quality of life and mental health (36, 37).
  • Take care of your mental health: Living with any chronic health condition can take a toll on your mental health and overall quality of life. It’s essential to take care of your mental health by practicing self-care and seeking medical attention to support any mental health concerns (38).
  • Treat sleep-related issues: Studies show that sleep disorders are common amongst people with HIV. Sleep problems like sleep apnea and poor sleep hygiene can negatively affect your health and worsen disease progression, so checking in with a medical professional is important (39).
  • Get help if you’re experiencing food insecurity: Not getting proper nutrition can negatively affect health and worsen disease progression if you are HIV-positive. If you’re experiencing food insecurity, visit this link to find a food bank in your area.
  • Develop a plan with a qualified healthcare professional: Even though there’s no specific diet recommended for people with HIV, working with a registered dietitian to develop a personalized nutrition plan can help promote optimal health.
  • Quit smoking: Cigarette smoking is more life-threatening in people with HIV than in the general population and can lead to a number of health complications, including lung cancer. If you currently smoke, consider taking steps to quit (40).
  • Limit alcohol intake: It’s best to limit your intake of alcohol. If you have trouble drinking in moderation or stopping drinking once you’ve started, or if you feel that you need or rely upon alcohol, feel empowered to seek support (41, 42).

Due to advancements in medical care, HIV-positive people can live long, full lives.

You can learn more about the long-term outlook for folks living with HIV here.

A nutrient-dense diet, regular exercise, consistent medical care, and a healthy lifestyle can help support your overall health so you can feel your best.

Summary

Getting regular exercise, taking care of your mental health, quitting smoking, getting proper sleep, and working with healthcare professionals to devise a personalized wellness plan are all ways in which people with HIV can support overall health.

HIV attacks the body’s immune system, destroying white blood cells that are needed to fight off infection. People with HIV have higher energy needs and are more likely to face deficiencies in key nutrients.

Although there’s no specific diet recommended for all HIV-positive people, following a nutrient-dense, balanced diet can help support immune function, prevent weight loss, and reduce ART and HIV-related side effects like decreased bone mineral density and insulin resistance.

In addition to regular medical care and following a nutritious diet, people with HIV can further improve their overall physical and mental health by getting enough sleep, exercising regularly, and developing a personalized wellness plan with a healthcare professional.